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FOR OFFICE USE: X- ------ ----- ---- " ______ _ __ ____ f- _.---_ 0 APPLICATION FOR SANITATION PERMIT Permit No. ------------------ -- -- --- (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 Count Ordinance o. 549. JOB ADDRESS OCAT ONfell, �Q � � ! -!! ¢!- W / \ Owner's Name------- Phone ------------------ Address �s�. --- ..- ------ - ----------------- Contractor's Name---- --------------------------- Phone:.3f Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel F] Other ❑ Number of living units: _- - Number of bedrooms _c7___ Number of baths _1il_-__ Lot size -------- ---/ia_ ________________ Water Supply: Public system T__`Community system ❑ Private ❑ Depth to Water Table 004-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [g-"Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------- ----------) No [New Construction: Yes 2-110 ❑ FHA/VA: Yes ❑ No ❑ 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 -----Distancye7_from foundation---1S--------Material--- ---- ----- --- - ---------------- -- ❑� No. of compartments----- .c�_---____.._._-Size_y__ Xs_X9._.___Liquid d _ epth_ _.j�----------------Capacity.,/_c2_P_q___ Disposal Field: Distance from nearest well_ )7 k9cP—._Distance from foundation_,2Z-_____-_-.Distance to nearest lot lin ..... _ Number of lines-------c -------.._ Length of each line-. a_�. 5=�/1'.Width of trench---.._.�_y------------------ Type of filter material__ � G�f ._Depth of filter material___;/.R_-"-----Total length---------- _�?_'___-----_____ � r Seepage it: Distance to nearest well_ _( -Q___Dista m foundation__luL?____..___.Distar;�e to nearest lot lines_______.._ 2 Number of pits._.QZ.___-._- -..Lining material-__ QG1-_-__Size: Diameter._.33_- -_-..__-Dept h.__..99-S_______________.. Cesspool: Distance from nearest well_________________Distant from foundation--------------------Lining material_-_..----_.___..___------.___.______-. ❑ Size: Diameter--- ---------- ------Depth---------------------------------------------------Liquid Capacity------------------------_--gals. Privy: Distance from nearest well------------------_------------------------------Distance from nearest building-----.----------------------..-___---_---. ❑ Distance to nearest lot line ----------------------- -------------------------------••----------------------------------------------------------------------- Remodeling and/or repairing (describe)=---------------------------- --------------------------------•--•------•-••------------------------------------------------•------•• --_----------- ---------•-------------•-----•---------------------------------------------•------------------------------•---------------------------------------------------- ------------------I------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------•---------•---------------------------------------------------------------------- ------ ---- -------------- ---------------- ------------------•-------------•--- -------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to laws, and rul an regulations of th San Joaquin Local Health District. (Signed)--- -- - A ------- ------- - -- -------------------- ----- --- ------ ---- - --- --------- --------------------------------------( wner and/or Contractor) ----------------- _--Title (Plot plan, showing size of lot, location of system in rela+io o wells, buildings, etc., can be p ted on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 1.,.� DATE---- ------------------------ = ---------------------------- .................... BY '----------- - ----- DATE BUILDING PERMIT ISSUED----_----------------- /----------------------- +----------- DATE--------- ------------------------------ ' Alterations and/or recommendations:."c'I_----}.---�_ __ _-___1.---_-1—� ]?---_-_— -'-� ..Ems .- �____- T_-__-__---- �- --- �.` ------------------------- ----------------------------------------- -----------------------------------------------------------------------•---------------------------------- ------------ ----------------- ----•-------------•---•----------------------•-------• ------ -----------------------------------------------------------------------------•----- ----------------------------•-------------------------------------------- ------------ -- -------------------------- --- ---------- ---------------------- -------------------- -------------------------------------- --------------- ------------------- --------- ------------------------------ FINAL INSPECTION BY:.. "--_� 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.F.0 O.