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FOR OFFICE USE: , e9 - - /� ff --------------- ------- _Z -- APPLICATION FOR SANITATION PERMIT Permit No. ..tz��COs -------------- /f�'---- (Complete in Duplicate) - __--- _-________.___ This Permit Expires 1 Year From Date Issued Date Issued �+`7 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.�5.,4c9.. JOB ADDRESS AND LOCATION-__._3._°Z ' '`� -------------------------------------------------------------------------------------------------------------------------------------------- Owner's Name------?�'� --- Phone -----•----------�-_-,-�-,t------------------------ -------------------- ---- Address /�1f ••- ......-I------------- ------ --�'`- 'G Phone-------------- ----- -------------------------- Installation ------- Contractor's Name---------�. -'- - --- ----- ^�-- -�° --- _'-------------------------------- W& J' / Z- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ g f / / �-,S --,------ -�'�'----------------- Number of living units: __. ____ Number of bedrooms __ ___._ Number of baths ._______ Lot size __.__ _._� Water Supply: Public system 0--c&mmunity system ❑ Private ❑ Depth to Water Table 'r.,i x? ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0--,Hardpan ❑ Previous Application Made: (If yes,date-------.------------) No [-'New Construction: Yes ❑ No �WA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �► Distance from nearest well_________________Distance from foundation--------------------Material----___---_-__..___---------_---•_---.-- No. of compartments-.--- - Size------------------------ -------Liquid depth-------------------------Capacity--•----- •------------ i Disposal Field: Distance from nearest we, _---- from foundation_...Q"� ______.Distance to nearest lot line___._.____. Number of lines-_ __Length of each line---3_G_______ _____Width of trench..... ----------------------- Type �_.-__---- -_•-- Type of filter material-Sf ._Depth of filter material-__ _ �__ ___.Total length----------- --------------------- Seepage ----------------- Seep ge Pit: Distance to nearest wel �3��.-----__Distance f m foundation__,��---._..Distance to nearest lot line----3<,-�,_' ©� Number of pits---._._-------- _-_Lining material-_ -----Size: Diameter----3-3-----------Depth........;ZS-_"___._--___--- 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 ------------ ------------------------ 9 anrepairing __ Remodeling d :__ _ _____ L_--__-_ 1 ....................... /or re apirin ---------- ----- Alkii �`3! rCec w` `------------------------------------- ------------------------------ --•-----------------------------------------------------------------•------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, end rules and gulations of the an Joaquin Local Health District. (Signed)----------------- ----- ------ -------- ---a- Owner and/or Contractor) - -------(Owner --------------------------------------------------------- - ----- ---------��- -- -------(Title) //� 0 (Plot plan, showing size of lot, location of system in relation to wells, b ildings,ketc., can be placed on reverse side). FOR D PARTMENT USE ONLY APPLICATION ACCEPTED BY-- -------- - DATE v - REVIEWEDBY------------------------------------------- -------------- ------------------ -------------------------------- DATE-------------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------- --------- DATE------------- ---------------- ------- Alteratiqns apd/o`r rem ndations------- ---------------------------------------- ---------------------_--- ---- � t----C ------ ---------------------- ---------------------------------------------- ------------------------------------ --------------------- ------------.-------------------------------- ----------------------------------- FINAL INSPECTION BY:----- &" n----- ----------------------- --------------- 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.