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FOR OFFICE USE: y z= ------------------ Q- -�- ---------------------------------------.-------- -------- APPLICATION FOR SANITATION PERMIT Permit No. . e'_ .. ------ - (Complete in Duplicate) Date Issued --- -------------------��-- -----------.---- --- 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------� .6_ Owner's Name ! ��__-...��"4-�'� ---------- --------------------------.- Phone--•--------------------------------- ------------------------------------------------------------------------ Address---_`f�.U_-�3..-- ---- 7s Contractor's Name ------------------------------------------------------------------------------------------------------- Phone................................... will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----I--- Number of bedrooms _2-_ Number of baths __t--- Lot size _J�X4_2_-3 0--------------------------------- Water __ __ _Water Supply: Public system ®' Community system ❑ Private ❑ Depth to Water Table 0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Eq--Hardpan ❑ Previous Application Made: (If yes,date--------------- ----) No 91'_ New Construction.: Yes ❑ No [ FHA/VA: Yes ❑ No n— 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-----------------Distance from foundation--------------------Material .._..________.._________...__________.__.___.___. ❑ No. of compartments_-----------------------Size----------------------------....Liquid depth--------------------------Capacity----------------------- Disposal Fi Id: Distance from nearest well-----------------Distance from foundation_A--------------Distance to nearest lot line_ /..... E16Number of lines-----L--------------_-------------Length of each line_aeo--------------------Width of trench._ -"___.__---_____--- Type of filter materia L_--lZe7r-.-----_Depth of filter materiaL_._L,Y_"-_____.Total length-------- ' Seepage Pit: Distance to nearest well----- ------------Distance from foundation__lsQ..._.___....Distance to nearest lot line-_--- ____�_.. ®� Number of pits.__/____._ __Lining material I—c-r_/(___.Size: Diameter__3.3__'__..__-_Depth-.__-_ZJ_-'___----____--• ."D 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 ------------------Remodeling and/or repairing (describe):.-__-__._ ------------------------------------•----------------------•--------•--•---------------------------------------------------------------------------•----------•-------- -•----------------•--------------------------------- ------------- ------------ ------------------------------------------------------------------------------------------------------------------------------------•--------------------------------- ------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, StatZI ,snand rules and regulations of the San Joaquin Local Health District. (Signed)-------------- ----------------------- ---------------------------------- ------------------------------------------------------------------------- Owner and/or Contractor) ( / actor) By:--------------------------------------------------------------------------------------------------------•--•------------------------(Title)---------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- - ------------------------------------------------------------- DATE---------/�IZZ 15-------------------- REVIEWEDBY------------------------------------------ ----------- ----------------------------- ---------------- ------------------ DATE---------------------------------------------- BUILDING PERMIT ISSUED--------------------- --------- --. DATE---------------- - Alterations and/or recommendations:. ��12- �''`�'`' ¢`=<<�--------------------- ------------------------ ----------------------------------- --------•------------------------ ---------------------- ----------------------------------------------------------------•------------------------------------------------------- ----------------- ----------- -----------------------------------I---------------------------- ------------------------------------------------------------------------------- --------------------- ------------------ ------------------------------------------------------------------------------------------------- ------------------------------ ------------------- ----------------------------- --------- FINAL INSPECTION BY:---.- - --------------------------------- Date------ // = '-" J------------ -------------------------- ------ 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.C o.