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p FOR OFFICE USE: ii APPLICATION FOR SANITATION PERMIT Permit No. _ �..�`�1 II (Complete•in Duplicate) V----- This Permit Expires 1 Year From Date Issued Date issued _._--s _-- :_. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thi's application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LO ATION--5 _�-%' _. atm - -------- ---------------- - Owner's Name: _. . ._ � `'----Y Phone ---------- ' . ------------------------ a t Address--------------- - -------------�-�'-�-'�•----------------------- - � --- ---- -, J7- j, --------------- ••-------------------------------- one ------------------- Contractor s Name--•-------- ---------------- -------� ----`�---� ------- �- =-----�'�----•---------. ------------- Ph ------ •-------- 1. n Trailer Court ❑ Motel ❑ Other ❑ 11 tion will - Number ath! - / ------- IniialaNumber of livingResidence � Number of bedrooms Commercial ❑ s ' - Lot size._.-. _--�---- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table .-_ _ : ft Character of soil to a depth of 3 fee+• Sand ❑ Gravel ❑ Sandy Loam ❑ }Clay Loam Clay ❑ Adobe❑ Hardpan ❑ t Previous Application Mader-'Ilf yes,date-_..------- ly No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tanVor-cesspool'permitted'if.public sewer is available within 244 feet.) Septic'Tank`: Distance from.nearest well-----------------Distance from foundation- .---.------Material ----_--___-_.-..--.---------------------.-----. i; ❑ s No. of compartments-}' -------------------Size-------------------- ---• ------Liquid depth--------- ------- --------Capacity ----------------------- Il i r -r..i / • C' Dispo'sa field: Distance from nearest well...- p..--..-Distance from foundation----�..•:-------.- Distance to nearest lot line__--._/__-------- I Number of lines.-_.--_-`;--- ----------------Length of each line---_--- - -..---___---Width of trench.--, ---------------------------- I r �. }� , 1 Type of fiEter-amater�al'.-:=--"-----x-�_-�'°�°'Dept`h of`filter material------- --"_..Total length-----6.°------------------------------ Selepage_Pit: Distance to nearest well-.--:-----------------Distance from foundation.------------.-----Distance to nearest lot line--.-------------- I 1 ------------.I1 ❑ .' Number of pits.-- ------------------Lining material--------------------- Size: Diameter-----------------------Depth---------------------------------t 9 !i i .s 1 v. . f/ Cesspool: Distance from nearest well ----------------Distance from foundation----------------- - Lining material---.-.--------------.--.----------__-. Size: Diameter- -- --------- ---- - - ----.Depth------------- - - ---------------------- ----------Liquid Capacity- --------------------------gals, d Privy: Distance from nearest well--__-- ---------------------- ---------------Distance from nearest building-__--------------------------------------- i Distanceto nearest loft line-------------- - -- ----------------------------- ----------------------------------------------------------------- --------------------- 1 R e m o _ ., deling and/or repairing (describ )�-` - ;... - - u � .-- i ------------------------------------------------------ -- ------- ----------------------------------------------------------------------------------------------------------------------------- q hh I N I 'by certif a+ I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State aws, and rules and regulations of the San Joaquin Local Health District. ' (S.igne�d} --------- ------- ---- - -- - ------- ---- --- --- --------------------------------1-- -------------------- -.. and/or Contractor) BY:---- ----- --------- _ ---- -------- ---- ------- ---------- (r+le}.---------------- -------- ----- - --- :-..... (Plot plan, showing size of lot, location of System in re tion to wells, buildings, etc., can be placed on reverse side). c : �i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ---------- -------------- DATE----�. — = '....C2�-- ----------------- REVIEWEDBY------------------------- - ----------------- -------------------------------------- DATE------ ----------------------- -----•----------------------- BUILDINGPERMIT ISSUED-------- -- ------ ------------------------ ------------------—-------------------------------------- DATE----------------------------------- --------------------- --- Alterations and/or recommendaf ions:------------ - - -------- ----------------- - ------------------------------------ ----------- ----------------------------- II 1 i ----- li i [ ----------------- - ...-------- --- --------- li i h ! IIFINAL INSPECTION BY:.._ _. _ J 1 y( L r T - - -- -_ - --- �_r�:---------- Date--/"2 --- :• � -- I: SAN JOAQUIN LOCAL HEALTH DISTRICT ' 1601 E.Hazellon Ave.~y 300 West Oak StreetT 1244 Sycamore Street 20.5 West 9th Street Stockton,California Lodi. California Manteca,California Tracyr California 5-H.9 2M 1-67 Vonguwd Press I 0