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FOR OFFI�EU�E: ✓ ----- j �3 �' -.--.-______________________________________________ APPLICATION FOR SANITATION PERMIT Permit No. �:�.........�� --- ---- (Complete in Duplicate)6 _ � o-• _.__ ------- -------------------------------- .._-_ ThiDate Issued s _Permit Expires 1 Year From Date Issued ._.____ 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 County Ordinance 549. JOB ADDRESS AND L TION ----- 1 -------- ------------------------------------------•---•---------•-•--- ----------------------------------- Owner's Name---------- •------- l-- - �---- -- -- --- Phone-------- ------------------- .. =Address -------------------------------------------- __ .� Contractor's Name--------------------- --- - /si -- Phone_ ........... -------------------- Installation will serve: Residence U?-IApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:._!__- Number of bedrooms .A. Number of baths _f-__ Lot size._'._..Q_______________________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _-V4?ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe @3 --Hardpan ❑ Previous Application Made: (If yes, date____________________) No New Construction: Yes grNo ❑ FHA/VA: Yes 29^' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .� Septic Tank: Distance from nearest well_____ -------- Distance from foundation--- __�l ---.Material-- -------- No. of compartments__,_ -,X---- ----- ---- size- _aL.(¢-._ ,_Zk*_.___Liquid depth ------ ___------ Capacity ...... AQa-_-_- Disposal Field: Distance from nearest well_-- — Distance from foundation___ 40________ -Distance to nearest lot line ---- ■,'.___ __' , i Number of lines_ _________ ___ Length of each line______Li-_-__..___-_-_.Width of trench ----- _ ____________._____________ Type of filter material � ___,rfBlfepth of filter material ------ /j?_4'e____Total length ....... 7- -�_---_.-.-__.__-__-_-__ I Seepage Pit: Distance to nearest well ________--------- Distance from foundation ----- ze.__..__.Distance to nearest lot line ------ [L}r' Number of pits_______ ____________Lining materia__ ��/_l�.Size: Diameter-___ _�_".. "---..Depth ---- -7___--------------- Cesspool: Distance from nearest well Distance from foundation Lining material 1 W ----------------- ------------------- ------------------------------------- ❑ Size: Diameter -------------------------------------- Depth ----•----------------------------------------------- Liquid Capacity ---------------------------- gals, Privy: Distance from nearest well ------------------------------------------------- Distance from nearest building -------------------------------------------- F1Distance to nearest lot line ------------------------------------------------------------------ -------•-------------------------------------------------------------------- Remodeling and/or repairing (describe) = •--------------- •------•---------------------•--------------------------- . `TINY__ --- ,�.- - ---• -- - -- -- --- - ------ -- -- s ---------- ---------------------------------------------------• -..--------------- --------------------- ..--------------------------------------------------•---------------------•-----------------•-----•------------------ I hereby certify that I have prepared this 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. (Signed) ----------------------------------------------------------- r Contractor By:--------------------------------------------------------------- ----------------------------------------- (Title) �---------.. ---- (Plat plan, showing size of lot, location of sy ; in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- ---------q..- s/ ------------••------------------------------ DATE------------------ ----------------------- REVIEWEDBY------------- ----- ------------------------------------------- DATE-------/->------------------------------------•------•--- BUILDING PERMIT ISSUED---------------------- -- ------ ------------- --------------------------------------- DATE------------------------------ ----------------------- Alterations and/or recommendations-------- ----- --------------- ------ -------------------------------------------------------------------------------------....---•--------•--------------•--- -------------------------------------------------------------------------------------------------------------------------------------------------•---•-------------------------------•----------------•- FINAL INSPECTION BY: ......... <2--t-- __::�------------------ --------- Date ----I-- __j6A------------- ----- --------------- 130 South American Street Stockton, California 99.9 REVie EO a-59 F.p.OG. AM B•SP SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 124 Sycamore Street 205 West 91h Street f Lodi, California Manteca, California Tracy, California