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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._/ SOJ (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.-pompliance with County Ordinance No. 549. 30 JOB ADDRESS AND LOCATION----2/Q-�, -IdlX-- ----—tc y�-v------ /-Z�.0 Owner's Name---------------j-�----------/__/ezvw.Z__ -S--/--O---F-�--9-�--«- � Phone-------------- - ---------------- .... �=Io'xl ------------------------------------------------------------ Address-------------------------------I Contractor's Name------------ 1 _ --------- ------------------------------------------------- Phone. "".-4�. �xQ Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms -3_ Number of baths _ Lot size ...... rw.,O---------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table/,��.. ft, 0 O Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ d Previous Application Made: (If yes,dote--------------------) No New Construction: Yes ❑ No E�FHA/VA: Yes ❑ No 'TYPE-OF-INSTAL:L-ATION AND SPECIFICATIONS: a::.r ;x_-_ .==. (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 Disposal Field; Distance from nearest well.l�T......Distance from foundation--------------------Distance to nearest lot line --Len th of each line....- `� Number of lines--------- -- -----.. -- g �5�.....--. width of trench.-- ------------------------ Type of filter material._ _ °��Depth of filter materiaL..fS --_------.Tofial length-.-.... �----------------------- Seepage Pit: Distance to nearest well___.._._......_-..__Distance from foundation...................Distance to nearest lot line................_ ❑ Number of pits-------. Lining material---------- ------------Size: Diameter------------------------ Depth---------_-----..____.-------. 1 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------------------------------------------ F1Distance to nearest lot line.----- ---- ----------------------------------------------------------- ------------------- ---------------------------- Remodeling and/or repairing (describe):------- � - ✓.----------.E--�4.��'`r.-�-------- ��...------------------��------------------------- -------------------------------•-------------------------------------------•----------------------------------------------------------------------- ------------------------------------------------------------------------ ----------------------------------- ---------------------------------------•---------------------------------------------------------------------------------------------- ----------------•---------------------------- -- ------------------------------------ --------------------------------------------------------------------•-------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I and rules and regulations of the San Joaquin Local Health District. (Signed)--.----- ---- f------ - .'lf'.--------------------------------------------------- ------------ ner nd/or Contractor) By..- - -------- - -----------------------------------------—(Ti � � ------------------------ (Plot 'j---(Plot plan, showing size of lot, location of s stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ �R-0. -------------------------------------------------------------- DATE----------- ` IJ-- 6--a-- --------- REVIEWEDBY-------------------------------------- -- -- -------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------------------------------------------------------------—---------------------------- --------- DATE--------------------------- - -------- - ---------------------- Alterationsand/or recommendations------------------------------------------------------------------------------------------------------------------------------------------------------------- -- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------•---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------- --------- - --------------- ------ -- --- -- -------------------------------------------------------------------------------------- ----------------------------- FINAL INSPECT ,�C- Date------------------�_. --T-/- --- ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California FY F.P.C D.