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FOR OFFICE USE: a � -----�-°---►- APPLICATION FOR SANITATION PERMIT Permit No. ,a23 - ----- ----- - ---------------------- -- - --- ------------ -- - (Complete in Duplicate) Date Issued -------- Application -----------_-----______..._._.___-_____...._- This Permit Expires 1 Year From 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 LOCATION/__ 1/ / :_11 /.TA? e ------'f.-i a__.___. _ .__�i��_ l_____. Owner's Name Z!o ----- ....� '-�--- -- ------------------------------------------ ------------ Phone------------------------------------. Address --- ,e� �� H' Jy�%9 -------- Contractor's Name------------ " --- ---------------------- ----------•-•--•---•------------ -•--•---------- Phone.................................. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/... Number of bedrooms _A Number of baths _/__ Lot size —--------------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Tableglo" ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2<ardpan ❑ Previous Application Made: (If yes,date--------- ----------) No E____New Construction: Yes ZT'Tlo ❑ FHA/VA: Yes ❑ No Rg--- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) el Septic Tank: Distance from nearest well_.6,t1------ Distance from foundation—A19___---_..Material�f_' _ _ e,,91� a,2 . No. of compartments- -- ----------Size! W___-TX_5___Liquid depth__%.�.__.....___Capacity-_01019-49------- Disposal i Disposal Field: Distance from nearest well_.,`-___ Distance from foundation,2.C__ ___-_.Distance to nearest lot line--------------_ Number of lines------%-__-._`____ _________ Length of each line__ ��_ Width of trench��_--_____-_-_--_.__.____-.--__ Type of filter material _ Ci Depth of filter material---1��_�_---._Total length____, __Q_�_______________-_-.--- Seepage Pit: Distance to nearest well... Distance fr m fo dation_Z�r----.Distance to nearest lot line--- __'------- Number .�_ 0� Number of pits._-/'--___._-._.Lining material.( _s<' _ ___Size: Diameter,_?j- _ __..__.Depthp_p __-___-----____-_ Cesspool: Distance from nearest well-----------------Distance from foundation-----.--------------Lining material _______--.--_.-_-:------------- .._ ❑ Size: Diameter----- ---------- --- --------------.Depth-------------------------------------------- -------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------------.--------------Distance from nearest building.__-__._-------------------------------- ❑ Distance to nearest lot line--y--------------------------------�---'---------------------•-•--------•----------------------------------------------------- ------------ Remodeling and/or repairing (describe) f�� / � ----•------------••-•---------•--------- -- ---•---- ------------------- - - ----------------------------------------------------------------------- ------------------------------------------- - ------- --- --- -- - 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)------------------------ t�_L- ----- -----------------------------------------------( wn r Contractor) By:---------------------------------------------------- - -- -------- - ---- - - ------------------------------- (Plot ----------------------------(rtle) - (Plot plan, showing size of lot, location of em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY p,� r APPLICATION ACCEPTED BY------------ l/�L ----------------------------------------------------------------- DATE----------7v/.ZI-------------------------- REVIEWEDBY-----------------------_ ---------_ ---------------------------------------------------------- -------------------------- DATE----------------- ----------------------------------------- BUILDING PERMIT ISSUED---------------------- --- --------------- --------- DATE-.----------------------------------------------------------- 0Alterations and/or recommendations:._._ _ ----------------------- ------------- 1 ----------- ----------------------------------------------- ------------------ --- ---- ----- ----------------------------------------- ------------------------------------------- --------------- -------------------- ----------------------I-------------- ---------------- ---------------------------------------------------------------------------------------------------------------------- ----------------- ------------------- -------------------- ------------ --------------------------- ------ -- ----------------------------------- --------------------------------------------------------------- ------------ ------------ ------------- ---------------- -------------------- -------------------------------- --------------------------,---- -------- FINAL INSPECTION BY:-- __._.�'.1__ ___.__-4 _ — -..._ 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.CC.