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FOR OFFICE USE: ------------------------------ � ------ APPLICATION FOR SANITATION PERMIT Permit No. ..�y[.....�Z' -- ------------------------------------------------------- (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. c JOB ADDRESS AND LOCATION- ------- ----------- Er/ �_<_t �- '? -..-. - 1 �- Owner's Name 1 Nf��e_/ ----_--•--------------•---------•-•---------------------------------------------------------------- Phone------------- Address................... ----- -----r! p /f f �YC ----------------------------------------•-- Contractor's Name :=-=- .r ? ,5� --------.: .= '--�------------------------------•--------- Phone �a,��y�l Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mot I ❑ Other ❑ Number of living units: ---/... Number of bedrooms ___!t'_Number of baths __/--_ Lot size _____________________ Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [3--Clay Loam [Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑—" New Construction: Yes ❑ No Ef 'FHA/VA: Yes ❑ No E-T— 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 ield: Distance from nearest well_,E2,,� -Distance from foundation_.-%__-_____.Distance to nearest lot line.:7�'� Number of lines-------1___________ __________Length of each line___�Q_�--__.___-_.Width of trench__2>; -'"---_--_--______-__ Type of filter material---��- ' Depth of filter material--,-/s-_'_____---Total length_-___� '.._`'___________________ Seepage Pit: Distance to nearest well-----_----------------Distance from foundation--------------------Distance to nearest lot line__.-_______.__-._ ❑ Number of pits--------.-------------Lining material-----------------------Size: Diameter------------------------Depth---------.----------------------- Cesspool: ____.___-________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 and/or repairing (describe):._--xl 7; Z_77 ---___ _'_,k /___ter�'' :" ----------- -`� -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------i ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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 regulations of the San Joaquin Local Health District. (Signed)- ----------------- _,�. =--�--------------- --------------- _ - - ----- ----.- . wne "nd/or Contrac B . ------------------------------------------------------------ (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----'TTR-U r-------------------------- ------------------------------------------ DATE--------- -------------- REVIEWEDBY-------------------------- --------- -------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------ --------...-----------------------------------------------------------. DATE------------------------------------------------------------- Alterations and/or recommendations---------------------------------------- ---------------------------------------------------------------------------------------------------------------------- - -----------------------------------------------------------------------------------------------------------------------------------•------------- ----------------------- --------- -------------------------------------- ----------------------------------------.----------------------------------------------------------------------------------------_------- --------------------- ----------- ------ - --- ----------------- ----------------- FINAL INSPECTIONS Date--- ---------U1-- �"' �- ------------------------- 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.CC.