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FOR OFFICE USE: -------------------------- ________._____._. __ __ - APPLICATION FOR SANITATION PERMIT Permit No. 2z ..... . ` � ------------- (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 ALOCATION-i�ce� -- , Y.c ,f�_- -- �4 .lt.�c_ +�---fir/. y----- --/10 _ Owner's Name--- Llf- ---------- ------ Phone.................................... � �cG 'e+Address. /J _ ------------------- Contractor's A e Contractor's Name------- -- . -u---- -- ---- ----•-- �---- -- .-`�Q•»--------------------------- --------------------•-- Phone..............------------------••. Installation will serve: ResidencApartmen Hose ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms 3--- Number f baths _ Lot size ___ C..______________________ Water Supply: Public system ❑ Community system ❑ Private /Depth Water Table -------- ft. 4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Depth Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date_________ __________) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well---��e_".____Dista ce from foundation-_..__L_O.--- Material------IU-7— -------------------------- � -at� 1r -/ "__Liquid depth-----E .�_.________Capacity__j _4_Q Dispos Field: Distance from nearest well_!t-Q-_-__._Distance from foundation...1.0-----------Distance to nearest lot liness_. Number of lines_--------�'--------_------------Length of each line-----iO__1___--_.--_-----.Width of french_--Z___-._-_--_-___._._-____.-_- Type of filter material-_._-_ Rt--------Depth of filter material-------l_Q-*.......Total length------ ----------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation._-.-_---___-._-__-.Distance to nearest lot line_-___-_.---____-• ❑ Number of pits-------.__.---.._.._.Lining material-----------------------Size: Diameter_----------- --------Depth-------------------.__-___---__-_ Cesspool: Distance from nearest well--------------.__Distance from foundation--------------------Lining material---___-.--_-_--_.-.__._-___--__--__. Size: Diameter---- ------------------------ Dept h---------------- ------------ -=-------------------Liquid Capacity_ --gals. Privy: Distance from nearest well -.-___-._ -----------------------_-------------Distance from nearest building-----._-_______._-_---_____-_---_---` ❑ Distance to nearest lot line------ -------------------- -------------- -----------------•------ Remodeling and/or repairing (describea_,_,tA ---------- _%----------- --------------------- - --------------------11Z ------ a-�- ---- -------------------------------------- -----------------------------I------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat ws, and rules and regulations of the San Joaquin Local Health District. (Signed) - ------ f,. �nd/or Contractor) B : ----- - -- --- - ----- Title ------- --------------------------- Y - ----- ---� - - -- - ---- - - ----- ------------------------------------- (rifle) plan, showing size of lot, location of system in re tion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.__ _____________________________ DATE_____ _�t !_i __.-_ -- -- -- ----------------- - ------------------------REVIEWED BY------------------------- ---------------- -------------------------------- ------- -------------------------------------_ DATE-------------------- ---- BUILDINGPERMIT ISSUED----------------- ----------------------------------------------------------------------------------- DATE----------------------- ------------------------------------- Alterations and/or recommendations------------------ -------------------- -------------------------------------------------------------------------------------------------------•------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------- --------------------------------------------------------------------------------- --------- ----------------------------------- -------------- ---------------- --------- ------------------------------------------------ ------------• ----------------------------------- ----------------------------------------------------------------------- --------------1-1------------ -------------- ----------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------"e----- -'- ----------------------------------------------------------------------------------------- FINAL INSPECTION --------------- - Date- - -------------- SAN -- -- -G-----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.