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FOR OFFICE USE: - APPLICATION FOR SANITATION PERMIT Permit No. ___ •-- ---• -------------- -------- - - --- --- ------ ------------- (Complete in Duplicate) 1 Date Issued ___�_.tz,l. ------------------_ �.-.-1 __----_-.__._-_ 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....ka`�' -[u y.r�.� --`-----------Owner's Name--------{-*-11,------'� t------ x,..S.__e__ ------------------ ------------------------------------------- Phone---------------------------•------- �Zu Address--------------------------- 7 t � G x-------7--- � Contractor's Name-------- -----k_�ZJ ------- 6!T�---------•------•-------------------------------.-----•-- --------•-------•---•--._. Phone................................... Installation will serve: ResidenceApartment House E] Commercial E] Trailer Court ❑ Motel F] Other El Number of living units: -------- Number of bedrooms Number of baths __ Lot size -------, ---------•-- Water Supply: Public system ❑ Community system ❑ Private epth to Water Tabl�_,,97ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date--------------------) Noew Construction: Yes No ❑ FHA/VA: Yes [R�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta : Distance from nearest well__ :5 --- .--_Distance from 'foundation--41__..--_---.Material--- ----------------_ No. of compartments----.-J_.__-J --- ___Size___ %_ � ___--_--_._Capacity----)-Zn-�___-- Disposal Field: Distance from nearest well---14-_/...Distance from foundation__{l_.0.........Distance to nearest lot line/-___-____ ❑� Number of lines----------- - i10_ __----.Width of trench_v�-_ --Length of each line__--_--_ <?--____-- - �---.-------------------•- Type of filter material------1_-1j,.1�.�Depth of filter material___ ------Total length-----—"!________________--___-.__ I . Seepag i : Distance to nearest well--- °._�_- __Distance�om-�oundation--�_Q_..__.__.Distance to nearest lot line. _____._-._ s Number of pits.,=�li�------------Lining material_i�1-------Size: Diameter ----Depth- ------_ -- o Cesspool: Distance from nearest well-------------_---Distance from foundation-----------.--------Lining material---------------------------.---_____-. ❑ Size: Diameter---------------------a----------------Depth--------------------- ------- --------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------------... ❑ Distance to nearest lot line.------------------------------------------------------------••---------_---------- �---------------------------------------- Remodeling and/or repairing (describe):_-_-.--- -- ,�-- x -..¢✓-'----------------------- --------------------------------------------------------------•------------- --------•--------------------------- ------------------------------------------------------ ----------------------- -------------------------------------------------•------------------------------------ --•---------------------------------------------------------------------------------------------------------- --------- ---------------------------------------------------•------------------------------------------------------------------------.------------------------ ------------------------------------------------------ ------- I hereby certify that I haveAanr d this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, a ruleulations of the San Joaquin Local Health District. (Sign -------------- t-- --- - -------------------------------- ed) ---------.(Owner and/or Contractor) By:-------------------------•-• ----- Eati --- - ------ -------------------------------- -----------(Title)_ �-✓- T.0— (Plot plan, showing size of n of system in relation to wells, buildings, etc., can be placed on reverse-side). FOR DEPARTMENT USE ON Y APPLICATION ACCEPTED BY----------- �ODATE-------------- ------ �---------- ---------------------------------------------------------- -- REVIEWEDBY------------------ -------------------- --------------------- ------------------------------- ---------------------- DATE--------------------------------------------------------- BUILDINGPERMIT ISSUED--------- ----------------------------- -------------------------------------------- --------- DATE--------------------------------- and/or recommendations:-------------------------------------------------------------------------------------------------------------------•------.._------------------------------- --------------------- ---------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------- ----------------------------------------------------- -------------------------------------------- ---------------- ------------------------------------------- ------------------------------------- -------- ------ --------------- ---- ---------------------- -------- -- --------- -------- --------------------------- ---------------------------------------------------- -------------------------------- -------------------------- FfNAL INSPECTION BY f!y -- ------ . Date-- 0--- ------- -------------------------------- 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.