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FOR OFFICE USE �•/ -- - J-E'Sr ------------ 'S G-�� -- ---- ----- -- -- -- - `� '. APPLICATION FOR SANITATION PERMIT Permit No. .�.y.�..�.�..... ------------------- - ---- - ---- (Complete in Duplicate) - -- -------------- --------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued -__/._Ge-_4rS' 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------- -,�'_ c -F� _, S?-- _ l Owner's Name---------------V_ _,-4--- ----------- --F--`. '-- ------------------------------------.- Phone------------------------------------ Address--------------------f ---------I Eit/_1 ------------------------------------------------------------------------------------------ Contractor's Name / --------------------------------------------- Installation -----------------------------------------Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1__-_ Number of bedrooms __3._ Number of baths I---- Lot size Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [4--Clay ❑ Adobe❑ Hardpan ❑ 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.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material ElNo. of compartments-------------------------Size-------------------------------Liquid depth------------------------Capacity--•---- Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line_______-____-____ ❑ Number of lines-----------------------------------Length of each line----------..-----------------.Width of trench-----------------------_--_-- Type of filter material-------------------------Depth of filter material------------------.----Total length_______________________-____-_____ Seepage it: Distance to nearest well_-- -----_Distance fro foundation__�1�__--__.DDiist Distance to nearest lot line----_C�__�_.-- Number of pits-._-.__-�_--_--_---Lining material___ e: Diameter___________ ------Depth- --•--z`�----------------- Cesspool: Distance from nearest well________________Distance from foundation--____--.-__--__Lining material-------------------- LA ❑ 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 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaqu- -- in C-ounty- - - - ordinances, State laws, an es d regulations of the San Joaquin Local Health District. (Signed) ----- / i _------------- ----------- n and/or Contractor) BY: ---- -------(Title)--- - ' -------- P of plan, showing size of lot, location of s em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------0......... _-s-_--__------_--_ , - --------------------------------------- DATE C fco_. �i_�-------- -------------- -- REVIEWED BY--- --------------------------------------------------------- ----- DATE------- BUILDING PERMIT ISSUED------------------ ----------------.----------------- -------• ---- " ` DATE__ ------Alterations and/or recommendations:- --------------- r Z. ---------- --------------------------------------------------------------------------------------------- ----------------------- - - -----------------------------------------------------------------------I----------------------------------I------------- --------- --- ---------------------------------------- -----------------------------------_---------------- -------- FINAL INSPECTION BY:.. --------------------------------- Date-----P-'-ZZ_' -------------------------------------------------- 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.CO.