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FOR OFFICE USS: ' 7/------------ ------ J APPLICATION FOR SANITATION PERMIT Permit No. ....f.... -------------------------- --------------- - I - ------------------------------------------------------- (Complete in Duplicate) t ______________________________ This'Permit Expires 1 Year From Date Issued Date Issued .___../..'. . >r• Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with Co ty Ordinance,No. 549. JOB ADDRESS AND LOCATION------/4*.--------,;0' ------- '-- - •-•-��'''��.-�'�"•-------•------------------------- --- - - - ••�1- �r' Owner's Name----------- tg y� Phone---------------- --- -------- Address. ' = -- ' � � ----------------------------------- ------- ------ i Contractor's Name --•� --- ---- Phone..............•----...._.__... Installation will serve: Residence ®,'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/___ Number of bedrooms -" Number of baths '`f .. Lot size 1.40C �___________________________________ Water Supply: Public system ❑ Community system Private ❑ Depth to Water Sable _04. Character of soil to a depth of 3 feet: Send ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g?"l lardpan ❑ Previous Application Made: Ilf yes,date-------------------1 No E--rNew Construction: Yes 94--No ❑ FHA/VA: Yes E— No ❑ k TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within-200.feet.) Septic Ta k: Distance from nearest wel -'_.- Distance from faun tion_!/_e�________-Mofe'r l__ _6_ - _. - _____________ No. of compartmerit3___� 5'__.__.__.__Size.� Ss'1 - :.+ iquid depth__: _f.-_ .___.._-_.Capacity_, ,e� __.__ Disposal Field: Distance from nearest well._-o* --_..._.Distance from foundation _ Distance to nearest of ©� Number of lines_-_____- Length of each lisle_ s Width'of trench__0Z_____ Type of filter material _ _Depth of filter maT'eriel_._ � -______Total length---.�r1P----------------------- Seepage Pit: Distance to nearest well------!!r'-"__-----Distance from foundation---/P....___.Distange to nearest lot ijpje_,_,T"_________ [t1' Number of pits----- __ ________Lining material._X. S-ize:,Diameter_ Cesspool: . Distance from nearest well_________________Distance-from foundation.----Vr'-"''--Lining�Ml aterial--_.__-_._._-_-"_-____________--___-_. Size: Diameter. ------------------: .--------......De Depth -••----•---••-•-----------------------------Liquid-Capacity ❑ >� p ,.; gals. Privy:. Distance from nearest well______________________________________________`._Distance from nearest building------------.________________________. ❑ Distance to nearesf:lot line_________________ ... ``- ------------- -�jj��------------------------ ;�� Remodeling and/or repairing (describe)--------------------f ---_"-------•----•-•-------------•---••---•------------- ----------------------------------------------------------------------- ------------------------- _______________________________ -------------------- .__.__.........-------------__--------..........__.,_-___.-_____________.___________________________.------------------------------------------------------ 'r-------- --------- ----------------------------E-_.- -------------•-------------•------•----....-•----- --------------------------------------------------------------------------------------------------- �\ Fhereby certify that-I have preparedithis application and"that the work will-be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. S (Signed)---------- -- � ----------------= - -----------------------------------------------------------( r Contractor) By:-------------------------- --- --{Title - ,------------- -- ----------- (Plot plan, showing size of lot, location of, em in relation to wells, buildings, etc., can .be placed on reverse side). FOR.DEPARTMENT.USE ONLY , APPLICATION ACCEPTED BY j-c ,. ��'t-J---------------- DATE---, z2ye � REVIEWED BY-------------------------- - DATE--------- BUILDING PERMIT ISSUED----�----------i-------------- ---------•--------- ---------------�----------------------------- DATE-------------------------------------------------.__...------ Alterations and/or recommendations: ----------------____ �__.._._. _ r _.. ------------------------------------------------------------------------------------------------------------------------------------------------------•••----•-----_.--------------------------------------------------------- ---------------------------------- --------- --------------------- -- ----------- ----------------- ---- ------------------------------------------------------------•-------------------------------------------------------•-----------------------------------•---•--•-------•--------•--------•-------•----------•---------------- 6 - Date - - / --- - FINAL INSPECTION BY:____...�.�_._�':.`._ �f--"-- � ----""""-- - ----------------"""-- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street; 4.124 Sycamore..Street 205 West 9th Street Stockton,California lodir California Manteca;Ca.11fornl�a Tracy,California ES•9 REvin Ec 6•s9 r.P.cc.BM s-so