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o -, FOR OFFICE USE: - 70------------------------ --�d r� _____________________________ _ __.____ APPLICATION FOR SANITATION PERMIT Permit No. -. .G�.�P. ---------------- -- (Complete in Duplicate) ---------- - --- ------ - ------- I ----- ---------- --- 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 County Ordinance No. 549. JOB ADDRESS ANDI ATION. .. o �N t+ /` Owner's Name-------- \ �/ -1y -0 I' -------------------------------------------------- ---------------------- Phone-T�. -•3-__92/0 Address \ ----------------- ---- ----- - ----- -------------- ----------------------------- --------------------------------------- Contractor s Name---- -------- -- �---$�---;��-'�-''y��-..= ------------ ----- --------------- ----------------- Phone.-_'�e�-_ -- ---- -T- Installation will serve: Residence U4-"Apartment House ❑ Col ercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: #2___ N mber of bedrooms .2--- Number of baths -I-- Lot size ----��_�__� c�_--------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _(Oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ule'lHardpan ❑ Previous Application Made: (If yes,date--------- ----- --- ) No ❑ New Construction: Yes ❑ No* FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S Distance from nearest well-----------------Distance from foundation--------------------Material ____________________________________.___.___. 4 No. of compartments--- -------- ----------Size------------------------------Liquid depth-------------------------Capacity-------------- -------- �1 �r-- Di a�F' Distance from nearest well_�`l. Distance from foundation__._11_�___ __.Distance to nearest lot line------- Number of lines.._._..__ Length of each line-.___ _---------_---Width of trench.__ j,[j, ` �� i i t. ------------- Type 1 "- � ._Depth of filter materia..__.__(__ g of filter material__ ___._Total length Se Pit: Distance to nearest well_A0_-4�_Distance from foundation----!t_. ___._.Distance to nearest lot line-______a -_ Number of pits._..___ ------- __Lining material---1 Size: Diameter_�Z-�f--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 building1, ❑ Distance to nearest lot line----------------------------------- ---- --- Remodeling and/or repairing (describe):._______ -h_ --____ Y- T ---------------------------------------------------------- ----------- .-IPF------ V------- ---;_m-adt--a- ---------------- ---------------------------------------------- -------------- --------- -------------------- -- - - -------- --------- ----------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------- 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 the San Joaquin Local Health District. OF 7relafion ------------------- d(le•Contractor) By:------------------------------------------------------------------- --------- - - ------------ - ------(Title)--------------_---------------------- -- ---- --------- (Plot plan, showing size of lot, location of system in wells, buildings, a ., can be placed on reverse side). OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ -- --- -- -- - ---------------------------------------------- DATE------ � -- -- - -------------- ------------------------- REVIEWED BY------------- ----------- -------- --- ---- - ------------------------------------------------------------------------ DATE------------------------------------------------------- - BUILDING PERMIT ISSUED • ----------- DATE - - - ----------------------------------------- �� r/ mendations: Alterations and/or recti -- 9 - y �--- 4�4---f — /_/ r�-�------�r- -- --------------Z., i� 4<4 jgJr_�rt — t / N+%e------- - - --------------- -------------------------------------------------------------------------------------------------------------- ---------------- ---------- ------------------------------------------------------------ f FINAL INSPECTION BY:.__. -----I---O �'._'�_- Date._..-_�` _ d - - - �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