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FOR OFFICE USE: - ------------------------------------------------ - APPLICATION FOR SANITATION PERMIT Permit No. ------- ............... .. -------------------------- ---- ------ ----------------- (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 per 't to construct and install the work herein described. 3 Sc� O This application is made in compliance with County Ordinance No. 549. +`p ` � I SS'Sf r. Fr F-T7-C s7- �' ..,,��/� � /' � q � �...s4.e�� JOB ADDRESS D L CATIO 1 1._-------- -------- - ------ - ------------------- --------- ` ----------------------------- Phone------------------------------------ -Nam �'l.p�rat"�a"'�'' p -- ----•- ----------- i Address--------�'-C1 ---- - ---- ------------- Contractor's Name___ ____ �� --------------------------------------------- Phone. --------------------------------------------- - 44THa P Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [ F� , Number of living units: -------- Number of bedrooms -------- Number of baths ________ Lot size ---._..__---_________. Se�-1Qp Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tablewo)X)ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---------------- _1 No ❑ New Construction: Yes LTJ ivo ❑ FHA/VA: Yes ❑ No _TYPE OF INSTALLATION AND SPECIFICATIONS:- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi ank: e Distance from nearest well_________________Distance from foundation--.-------�.......Material----------------------.------._.__.--------_----. Ef No. of compartments-------------------------Size---------- - •----------------Liquid depth---- ------ -- - -------- Capacity...-------------------- oho Disposa eld: / Distance from nearest well�Q ._._Distance from foundation__ _____.__Distance to nearest line___. - ------------------ TypeNumber of lines______�"____________________Length of each line__x5f?..-____/a0 -.-Width of trench_._.ri__._1__.____..____.___.___ � Type of filter material_r_J_?ffi.G/Z--------Depth of filter ............Total length------ .0-------------------------- Seepage Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest lot line_-_____._________ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------------------- Depth--------------------------------- Cesspool: Distance from nearest well_________________Distance from foundation------------------- Lining material__._...__________________.________ ❑ Size: Diameter-------------------------- ---- ------Depth-------------------------- ----------..Liquid Capacity----------------------------gals. Privy: Distance from nearest well___----_-----------------------------------------Distance from nearest building----------------------------------_---.-. ❑ Distance to nearest lot line-- --- ------------------------------------------------------------------------------------------------ ------------------------------------ Remodeling and/or repairing (describe)-------------------------------------- - ----------------------------------------------------------------------- --------------------------------•---- ------------------------------------------------------------------------- -•------------------------------•-----------------------------------------------------------• ------------------------------------------------ --- ----------------------------------------------------------------- ----------------------------------------------------------------------;----------------- •----;---------------------------------- ----------- ------- --------------------------------------------------------------------------------------------•----------------------------------------------------------------------------------------------------- ------------- ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State, 1,&s, and rules d gulati sof the San Joaquin Local Health District. L Owner and or Con+ractor (Signed) ----- ( ) - - ------------------------------------- e (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). T? FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ---gy_ 1_-?_0--------------------------------------------------------------------- DATE-----I --.ZS�" .----------------- REVIEWEDBY--------------------------------------- -------------=------------------------------------------------ ------------------ ;DATE-------------------•---------------------------------------- BUILDINGPERMIT ISSUED-------------------'-----------------=--------------------------------------------- ------------------ DATE------------------------------ ------------------------------ Alterations and/or recommendations:---------------- -=-------------- ------- ------------------------------------•-----e�-------------------------------------------------•--------------- --------------------------------------------- ------------------------------------------------------ -------------------------------------------•----•-------------------------------------------------------_------ ------- FINAL INSPECTIO Date............1,9 ` 7e �s SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r•.a.c o.