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FOR OFFICE USE: --------------41A-0 ------- ------------------------- -------------- - - - - APPLICATION FOR SANITATION PERMIT Permit No. ----�_?Z.��-- -------------- Com lete in Du licate- ------- --------- --- - (Complete Duplicate)) Date Issued ._� to 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 degcribed. This application is made in compliance with County Ordinance No. 549. M ►FNTEC� JOB ADDRESS AND LOC -TION_.__ ._... ._, :__��r,�✓ ,_... Owner's Name ------• --................-- --- ----------------------- ------------- Phone--- ---------- Dooti- 1,0 MF- 1>`AdEnt Address----------- 1- ,lam ---- �� 7--- -� ScNooc_ ©^l °� t_D� Contractor's Name-------- ` -------------•---•------------------------------------------------------------------ Phone..........................-------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _, __ Number of bedrooms ...`g_.. Number of baths /-- Lot size ,/ .........a--___-__- Water Supply: Public system ❑ Community system ❑ Private ®/bepth to Water Table Ae ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes �No ❑ FHA/VA: Yes Z/'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__J__11"_Distance from foundation----/, __..Mate�al.._4_ No. of compartments. � �� q p pacify.. compartments...Z.- Size".7,<_-- . ,e-'/_.Li uid de th__._ .�------_-._-_Ca as � _-- ,r f- � s Disposal Fi Distance from nearer{ well--- �____-.Distance from foundatiQn.o2a.........Distance to nearest �t linew ` _.._. Number of lines..... _.__-.-_ Length of each line__4__"__._ ;y._-Width of trench--�---_-__�_________________ �or Type of filter material_ /_ t Depth of filter material_.__.,�r_____-__Total length_..-_.,A.�.�_______________________ 3 Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line-----........... f, ❑ Number of pits______________________Lining material-----------------------Size: Diameter--------------------.__Depth-------_------------------------- 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------------------------------- -----•--.---- ---- ----------------------------------------------------•-----•-- : . �� Remodeling and/or repairing (describe: pv - -------•---•--------•---•--- ------------------------------------------------•-------------•-----------------------•--------------------------------•------------------------------------------------•-------------------------•-------------------- ------ ------------•--•------------------------------------••----------------------------•---------------------•-----------------------•---•-------------------------------------------------------•------- ------------------------ 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 th_VL�e San Joaquin Local Health District. (Signed) eg ------------------------------------------- Contractor By:----------------------------------------------------------------------------- -- - -- - - -------------------(Title)---- -------- - -- -------- (Plot plan, showing size of lot, location of system in tion to wds,buildings, oft., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----__l-_--)-_-^p---'O------------------------------ ------------------------------------------- DATE......3--II-�i REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations------------------- ------------------------------------------------------------------------------------------------------------------------------------------- •--------------------------------------- -------------------------------------------------------------------------------•-------------...................-------------------------- ------------------------ -----•-------------------------------------------- ------------------------------------ -------------- --------------.................................................................. ----------------------------------------------------. FINAL INSPECT! - ----- Date-------- a-•---j/L - _ 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 ES 9 REVISED B-59 3M 3-'63 F.P.CO. ..