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FOR`OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. _ -3- ------------------- ------ ---•------- (Complete in Duplicate) Date Issued -----------------------.- ------ _ -- ---- ---- `-...-_ -- --. This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in,compliancetwith County Ordinance No. 549. a} : ®o S-- f.30 —30 2S 3'? q til. Eu ri.t cam_ JOB ADDRESS AND LOCATION---- ...... ......... -. - --- ----- { *---------------------------- Owner's Name . .l1[f � ---------------------------- Phone------ ----------------------------- rGsd -- Address__. c/�__h--- - ----------------------•----••------------------------•---•....---..-..----•--------------•--------- Contractor's Name-- ---�7 ----------------------- --- --- •----•-------- Phone--------•-••-----._--._------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [❑ Motel [❑ Other ❑ Number of living units: ________ Number of bedrooms -------- Number of baths ______ Lot size ___-.____--__--___________________________________________ Water Supply: Public system ❑ Community system ❑ Private Ej Depth to Water Table jo__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam PP Clay ❑ Adobe❑ Hardpan,a Previous Application Made: (If yes,date_______________....)'-No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No se tic-tank, cesspool ermifted if ubhc sewer is avail- 1` within feet:`__ ( A r P P p } Septic Tank: Distance from nearest well_________________Distance from foundation-----------------,_Material--------____-_----------------------- ----__-_._. ❑ No. of compartments--------------------------Size-------•------- --------.-------Liquid depth.-------------------------Capacity---------------------- (" Disposal Field: Distance from nearest well__ _.Distance from foundation_- ------------Distance to nearest lot line`--------- V? Number of lines-----------------------------------Ldn th of each line---------------------,--------Width of trench----------------.------------------ � Type of filter material____..-_--__.---__--_-Depth of filter material----------------------Total length__________________________--____-__. Seepage Pit: Distance to nearest well,__ ._#4.._.1-___Distance from foundafion____ f___-_.-. Distance to nearest lot line..___.--,_._._ Number of pits---/------ ----- __Lining material_ _.__...Size: Diameter----- _____ De to-. _ Cesspool: Distance from nearest well___________ _____Distance from foundation.__------------- Lining material------------------------_________.._. ❑ Size: Diameter------- ------------------------------Depth--------- -` _------------------------------------Liquid Capacity- .-------------------------gals. I 4 I Privy: Distance from nearest we[I__-------_________________`--------------------Distance from nearest building---____------.__--____ ❑ Distance to nearest lot line-----.---_-__--.__ �- - --------- ------------------------------------- ------------------------------------------------------------ Remodeling and/or repairing {describe): -�-�--- ------- -- ------- ------y�------ ------- --- -----------------------•------------- ------------------- -- -- -- --------------------- - ----------------------------------------------------------------------------......•-------------�~W---• = --------•--------------------------------------------------------------------------------------- - --------------------------------- ------------------------•----------------------=----------------------------------------------------------------------------------------------------------------------------------------- I I hereby certify that I have prepared this application and'that the work'wili be_done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health Disfrict. - �� - i (Signed) � 1 P ----------------------- --- ------- ---------- -.-..- (Owner and/or Contractor) ---------- --- ----= - =------------------------------ Tide - .. - --.._.__ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY s , APPLICATION ACCEPTED BY--- ----------- --- ---------------------------------------- DATE--- REVIEWED ATE--REVIEWED BY-------------------------------------------- ----- ---------------------------------------- --------------------------------- DATE----------------------------- ------------------------------ BUILDING PERMIT ISSUED-------------------------------------------------- --- ----------------------------------------------------- - --- ---- ------ --- -------- DATE------------------------------- ----------- -- ------------------- Alterations and/or recommendations:._.. --- -------------------- ------------------------------------ ------------------------- ------ - ------ ------------ --- ----- - ---- • - ------------------------------------------------------------- ------ ----------------------------------------------------------------------------------------------------------------------------------------- ------ -------------- ---------------------•--------------------------------- --- ------ --------- -- ---------- ---------------- FINAL INSPECTION BY: Date---3-~Z-� ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.p.CO.