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FOR OFFICE USE: 31 ^> APPLICATION FOR SANITATION PERMIT Permit No. .. ............. 4 q (Complete in Duplicate) — --_._----__-_ ____ --------- --------- This Pe�rlitjxpires 1 Year From Date Issued Date Issued /o - -. � 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 LOCATION---------- ------------------------------------------------------- ---- --- ---------� -------- -- -------- =�-W---------- Owners Name-------- ---- ,�/%,�'r' f`1` = � ----- ------------------ Phone L'F� Address-----------------------------ft Z------------ �=--------j J/y %-� -;/!._/-7----- --------- j {Y---------------------------------------------- Phone.-_75/K4 --------------------- ---------------•--- Contractor's Name -� �'/' fzt ' C 1 5 �'' r�/ � (`-----------_. Phone."z�- 9 ''= Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Kjotel ❑ Other ❑ �s }.' Number of living units: ---/__ Number of bedrooms ___�r_ Number of baths __'___ Lot size -/_/.�!_T1.�f-c:_ _ _�_'__�'.._______._..._...__.._ Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam IR Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---------.----------) No,[ New Construction: Yes ❑ No Q_ FHA/VA: Yes ❑ No 21 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___--.-_--_-_.._--.Material-_----.-.-____.-.-_.-_-___-_-_---.-_...._-__-__-. ❑ -`'No. of compartments-----------------------,--Size---------------------------- ..Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well_.!).._.-._Distance from fo n"dation---/___�---__.--Distance to nearest lot line: 'i&-'.__. Number of lines--------1_- -_Length of each tfS°�.4'__<<f ---------------Width of trench _/--_-------------- ..... Type of filter material_-`. �'i��1'__Depth of filter material_ j--: . -Total length__ ,_,rr_J�_'_-_--.r_� Seepage Pit: Distance to nearest welL___ '�___Distance fro foundation____�:c. _,.._...Distance to nearest lot line__✓`____:_.. SN -- jZ Number of pits---------�_-- -Lining material---`'` 4-rSize Diameter "� '-._---__-Depth :.' `i.._:__. .. ___.. Cesspool: Distance from nearest welt.,--------------Distance from foifndation--------------------Lining material....-------_ -. . _ ._ ________❑ .Size: Diameter------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------- ----._-__.Distance from nearest building--__-- -__.._-_-__-____.------------ Distance _ _--__.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 laws, and rules and.regulations of the San Joaquin Lo¢ai Health District. (Signed) = , t �'� / /_� I '/� � / 1 �r ------ wrier and/or Contractor) BY:--------. . ,..�--.�.�_!:_z-,_ c k--------------------------------------------- --------- -------(Title)-- :K_: -nom: ---- - -------------- (Plot - ----- -- (Plot plan, showing size of lot, (ocati`n of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ -- ---------------------------------------------------------- DATE--------- ��-£'-------------- REVIEWEDBY----- ---------------------------------------------------------- ------------------------------------------------------ DATE--------•-------------------------------------- BUILDING PERMIT ISSUED---------------------- DATE------------------------------------------ --------------- --- -------------- --------- Alterations and/or recommendations:------1 � ---�--------- �-1- -- ----------------- ------------------------------------ ------ ------------------------------------•---- ---------------•------------------------------- -------------------------------------------------- ------ -------- -•------------------------------------------------------------------- ---------- -------------------------------------•-------------------------- -----------------------------------•-------------------------------------------•-------•--- ------------------------------------------- -1-------------------- --•----------------------------------------------•----------•-- --------------------------- -------•------------------------------------------------------- ------------------------ -------- ----•- --------------------------------------------- ----------------- -------------------------- -------------------•----•------------------------------------------------------------------------- ----------------------- ---------------- ----------------------••---------------------•----- ------------ -------.._..------------------------------------------- FINAL INSPECTION BY:.---- --- , ---- -------------------------- Date--------- ' - 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.C C.