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1 FOR OFFICE USE: - -21 APPLICATION FOR SANITATION PERMIT Permit No. ..... ---- - -------------------------- ------------------------------ (Complete in Duplicate) �:_:-:______ .._.. __________-_____.____-_________________--__ 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 AND LOCATION_..-r_•3.__/__,_1x_. Owner's Name �.� ,ll , / ! _fir. `N ---------------- Phone, __#'e_� � Address---------- . Contractor's Name,- R,�" �•t' -/E'. I S/ ..�� f►/G------------------- Phone.......................... ----- Installation will serve: Residence U�- Apartment House ❑ Commercial [I Trailer Court ❑ Mot 1 ❑ Other ❑ Number of living units: ---_ Number of bedrooms __Y Number of baths J--- Lot size ---,,---p- 1'•�'.�Lr'.�F------------------- Water Supply: Public system E] Community system [-] Private ig Depth to Water Table d__-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam U� Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date------------.-------) No JR New Construction: Yes Q No a FHA/VA: Yes ❑ No o 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._,121_-"._Distance from foundation__- ------Material--- -------- No. of compartments___ T--------------Size__ _X df'X._ --------1'Liquid depth_.._4_74_`_ _ p y Disposal Field: Distance from nearest well . ____Distance from founda�t�ioFn__/.. --_--.Distance to nearest lot line_________________ (� Number of lines-------- _-Length of each line-'a� 1I ��Width of trench-..,2_ _____ Type of filter material___04�k�_;r------ Depth offilter material--I --------------Total length----- 11? _ 37 Seepage Pit: Distance to nearest well--------------_-------Distance from foundation--------------------Distance to nearest lot line_---___._-__.__.. ❑ Number of pits---------------.------Lining material----------------------- Diameter--------------- -------Depth----------------- ---------------- Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material---._.-____-_-___.-_.___._-.... Size: Diameter---- .._____-_Liquid Capacity gals.❑ ---------------Depth-------------------------------'---------- q P Y----------------------------9 f Privy: Distance from nearest well--------------------------- --------------------Distance from nearest building____________.______--_____-_-.._..-____-- ❑ Distance to nearest lot line--------------------- r------------------------------------------ ----------------------------------------------•--------------------- Remodeling d/or repairing (describe):______F�--:_ G. /j� J__.Q_ - 1- -/�'C_ G"_______________________ -------- .sr °_„�-r - ------- ----- --- - --- -------- ----- ------ -- yn ---------15114 1 - Q K!� C fD `rte �2Slf .€T" r Oi- gsT(f�f - t'T� Rt+l � =T� ftlT Rl>rcT com-i.>c 1 At I hereby certify that I have prepared this application and that the work will be done in acor a M"wiii harm'oa4un u ty ordinances, State laws, and rules and lations of the San J a Local Health District. 7',R (Signed) 4sizeof J--.- 1� `,f,17 -Q 1 - -- caner Ad/or Contractor) f By:------- �ofsystem -- --------------------------------------------------------(Title) - -� -------- --- - - ---- --------- (Plot plan, showingelation to wells, buildings, etc., can be placed on reverse side). y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----_..-�s--�-O ------------ ---------- --------------------------------------- DATE `I ' �tt REVIEWEDBY-------------------------------------------------------------------------------------------- ---------------------------... DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------•---------------- --- -- DATE------------------------ -------- --------- Alterations and/or recommendations:------------------------------------------------------------------- ------------------------------------------------------------------- ----------------------- ------------------------------------------------------------------------ --------------------- --------------- ----------------------- ---. I y__-__--- ._-.._--_ -. -_--._-_ .................... c.. -_---. - d_____ - __.__.______.___ ._-----------.--------------------------------------------------- ----_...._---_-------------._...___--_.._---__-..__ ___._....__ _._..__._._.._ __ ___. ------- .......------.__.__-._...--.-____--__-._..-.-.--_---------_-__._`___-..-L--_/-�__._____...._.---._.........-__-___-_-.- FINAL INSPE N B ----- - --- ------- Date----------- / uv---- 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