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FOR OFFICE USE: / tt ----- ---------------_----------- APPLICATION FOR SANITATION PERMIT Permit No. . - � --------- ------------------------------------ -------- (Complete in Duplicate) -----------.-----------.--------------------------------- This Permit Expires 1 Year From Date Issued 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCAT ON ----- �0-✓�f e----- -----------------------------------------_------------------ Owner's Name .N_........?r .11�!�_�-------------------------- ------------------ Phonwi Q�~ Address Q ,r'4l1�-----.�fJG"�.1.!.111/ Contractor's Name---------------- 7. �9-"o— .E----------------- ------- PhoneIr,iG�. Installation will serve: Residence 0/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/.- Number of bedrooms _-, -- Number of baths ._ .. Lot size ._-_--tom_ *10 Number Water Supply: Public system ❑/<ommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Q--Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No Ep"' New Construction: Yes ❑ No D' FHA/VA: Yes ❑ No S- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic flank or cesspool permitted if public sewer is available within 200 feet.) 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---J------------Distance to nearest lot line...4. Number of lines--------- ----- --- ----------/---�--Length of each line-----�6?----------------Width of trench-------- --.-__.--..---.-----..----_--._.- -100 Type of filter material-_r� �,�•-Lrr-�f4 of filter material-----------------------Total length---------- ---------------------- 00 Seepage Pit: Distance to nearest well------- ----------Distance fr9tps foundation_-.Ctf?----------Distance to nearest lot line.Via._ --_.J b,/ Number of pits---- Lining material Size: Diameter__A,;.�....------..Depth---,;?.%,!r-Jr--------------- Cesspool: Distance from nearest well-----------------Distance from foundation-_ ----------------.Lining material------------------------------------- 1-1 Size: Diameter--------------------------------------Depth-------------------------- -------------------------Liquid Capacity---------------------•--_-gals. Privy: Distance from nearest well----------------------------------_------------.Distance from nearest building--.--..-_-._.--.--_---__-----.---------.-- ❑ Distance to nearest lot line---------------------------------- ---------------------------------•--------------- ---------------- R.emodelin and/or repairing (describe):------#F" G2-...- ---------------------------------- . � , , -----•- ------------------ - -------------------------------- ------------- -------------------- ------------------------------------------------ -------------------?--�--- ---=--------------------------- ------ 0- . ��1-�! � Al _ 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 d rules and regulations of the San Joaquin Local Health District. (Signed)------------------ - � �-- -C..._.— -�er and/or Contractor) By:---------------- --- ------ ------------------- - -- -----------------------------------------------.--(Title)-- --------+---------- (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 / APPLICATION ACCEPTED BY----- -- ." - ----------------------------------- DATE------ %IX4�� ------------------- REVIEWEDBY----------------------------------------- -------------------------------- ----------------------- DATE...--------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------------------------------- --------------------------- Alterationsand/or recommendations-------------------------------------- ------------------------------------------------------------------------------------------------------------------------- --------------------------------- --------------------------------------------------------------------------------------- ---------------------------------------------------- .......................... - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------ ------------------ ---- ------------------- - ----------- -----------------------------------___--------------..------------------------------------------------------------ --------------------------- --------------------------------- -- --- --- ----------- ---------------------------------------------- FINAL INSPECTION BY: / = 1 . ----- - Date �/ 3 �� 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.CC.