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)R OFFICE USE: V 7 -- ---- --- /a I APPLICATION FOR SANITATION PERMIT Permit No. •!-. ... :�� .. - --- - -- ----------------------- (Complete in Duplicate) S G� 9 ----------- Application Date Issued yy X111 ____________________ ______ 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. .554�9. �J JOB ADDRESS AND LOCATIO ---------------y-- -----�Q - /li-----G�. f/ �fJ�( --------------------------------------------------------------•----- '�f1-----•-------- e�Z��/ 'j__ Phone Owner's Name_____________ _ j Address------------------------- �-------- -,�l��-lr---U---Q�fJJlX r Contractor's Name �/E� �--5-- �1.-- �------------------------- Phone_ (/_,�� ------�� . Installation will serve: Residence Rl_<partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/___ Number of bedrooms _ZNumber of baths -- � �_ � ", Lot size "s`------------------- --- - --- --- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam n- Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No D---New Construction: Yes ❑ No E]--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_____...___._.__-___-.___.______-__...___.__. ❑ No. of compartments------------- ------------Size---------------------------- ---Liquid depth--------------------------Capacity---------------------- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----------------- El Number of lines-----------------------------------Length of each line---------------_-----------___Width of trench----_---.____________..__.________- Type of filter material----------_-------------Depth of filter material----------------------- length------------------------------------------ e ____.__._______ _-___--___._____--___--_.e f Seepage PDistance to nearest well------- fro foundation___-1�------_.Distance to nearest lot Number of pits------- ------------Lining material---�. 27ize: Diameter._4.M.`*...__.Depth_.."�7�__!__-. ------ .J,� Cesspool: Distance from nearest well----------.-_-_Distance from foundation--------------------Lining material---------_________.__.__________..__ 1- C Size: Diameter--------------------------------------Depth-------------------------- -------------------------Liquid Capacity-.-.------------------------gals. Privy: Distance from nearest we{I-------------------------------------------------Distance from nearest building ---------------------__.._. C Distance to nearest lot line- ------ - - --------------------------------------------------------- ---------------- Remodeling and/or repairing (describe):------ � -__ Q_-------_--�,iI`Z_5 ___. -- 6 ------------------------------------------- - 0 --------- -------------- ----------------_---------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------- 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, a es and regulations of the San Joaquin Local Health District. .�---� ^ (Signed)-------- -------------- -- ---- -- -- ------ - 5 .-- ------------------------------ �_ er Contractor)d/or Contctor)Sy:_------------•-t-� �----------------------------------------------(Title)--- ------ �----------.---- ------------------ (Plot plan, showing size of lot, location of stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------0i _ _- ------------- _............... /7��- -------- DATE----- REVIEWEDBY---- ------------------------------- ---- ------------------- ------------------ ------------------- --------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------- ------------- ------- -----------------------------------------------------------------. DATE--.----- � --•- ------------------ Alterations ander rem`ommmendations:------- --��----- - _^ e—_e�e�e.��r� - , ---_�,/ ---- -- - - ---- -------------rr-- --- cam-----' 4 ------------------------ -------------------- -- - ---------------- -------------------- - --------------------------------------------------------------------------------------------------------------------- - ------- ------------------------------------------------------------------------------------------- -------------------------------------------------------- -----------------------------/---------------- -------------------------------------- ------------------- ------------------------------------------------ -------- FINAL INSPECTION BY: _�_�. � �-✓ _=..._ Date_.-.. _.._. --- -- --------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Nozellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California