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FOR OFFK jSE: __ _'----------------------------------- �------ APPLICATION FOR SANITATION PERMIT Permit No. _Z..........................1.__. -------------------------------------- ------------------ (Complete in Duplicate) This Permit Ex fres 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------------2--1[. ....------ l-- ------- _6�_e-ro-------------------- ----------------------7-� - Owner's Name------------------------------------------------------------- `-i---'----- - d-N----------------- Phone-- O`r_ p -------------------------------------------------------- -. -- --�- ---�----------------------------------------------------- ---- ----------------------------------------- Address Contractor's Name-------------------------------------------l�_d ,- -'s�-�-------1�C"---------------------------------------------------- Phone..-Y_lA_�p_36_07 Installation will serve: Residence V Apartment House ❑ Commercial ❑ Trailer Court ❑ Molten ❑ Other ❑ Number of living units. __.l____ Number of bedrooms —Number of baths ---I--- Lot size ---CO.- — Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam J"N Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: [If yes,date--------------------) Nov 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--------------------Materiaf-------.--------__.__---_.-.__._-_--..-.------.-. ❑ No. of compartments---------- ---------------Size-------------------------------Liquid depth--------------------------Capacity----------------------- 1 / Disposal Field: Distance from nearest well---- ----------Distance from foundation- �-�-_____..__Distance to nearest lot line_-----___.-_-- Number of lines______________ _ Length of each line--_____ 1.4------- of trench----- _ ----.-----___.-- ' ,f Type of filter material _9� GV..._Depth of filter material __.__I_ -_._------- Total length------------------ _____________________ �y Seepage Pit: Distance to nearest well------.—----------Distance frofoundation---30..........Distant e to nearest lot line_] .___.._ S ( Number of pits-----------1-_..------Lining material-4s S?C%&...Size: Diameter-----33___...---Depth------- ----------------- Cesspool: Distance from nearest well-----------------Distance from foundation...-----------------Lining material-----.-___--.----______-.-_-_____. �- ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity--------------- ---- gals. lJ Priv Distance from nearest well_______________________________________-------._Distance from nearest b0clin []Y: ---------------------------------g-------------------------------------- p Distance to nearest lot line_ ______________________________________ l .i2 5`lf Remodeling and/or repairing (describe): A I�OfJ. � {N - ------ ------------ ------ 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 rules and regulations of the San Joaquin Local Health District. (Signed)---- --------------------------------------- _ RI.SIU G ---------------------- ----------- { caner and/or Contractor] By:--------------------- - ---------------------------------(Title)------ - ---------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- 7�1------- DATE..___S=_.�f 6 _r__ ----------------------------------------------------------------- ------------ ------------------- REVIEWEDBY-------------------------------------------- ------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUI LDI NG PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------------- -------------------------- Alterations and/ r recommendations--------- ---- ------ --------- - ------------ ---------------------------------------------------------------------------------------------- ---------------- __ 7 - - 0/} - ------------- ---------------------------------- - ------------------------- ------------------------------------------------------------------------------------------- ------ --- ----------------------------------------------------------------------------------------- FINAL INSPECTION $Y:. `-� - ------------ Date - --------- ---------------------------------------------------- SAN ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocktonr California Lad!,California Manteca,California Tracy,California F.P.CQ.