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t FOR OFFICE USE: " ------=-- --------- ------------------ APPLICATION FOR SANITATION PERMIT Permit No. _- -•- •---•- ------ ---------------------------- -------- Q --------------------------------------------- ------- {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, s7 p p k JOB ADDRESS AND • '��'f�`�`-'-- -- ' �j � Owner's Name----- -��I�__----- 1�ril_�_ .rSD,� ---------------------•------------------------- -- --- ------ Phon �' -- - Address_ _ ^� _ / Contractor's Name--- -__-� _W �«�-------------------------•--• ----- ------ Phone.�d� l� Installation will serve: Residence I;V Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Of her ❑ Number of living units: -------- Number of bedroomsA__ Number of baths _1____ Lot size __ - ,--------- 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 ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No 5 New Construction- Yes Ur No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND.SPECIFICATIONS: �;- [No septic tank or cesspool permitted if publivewer is available within 200 feet.) Septic T nk: Distance from nearest we e_-______Dist e rom oFdavn-�Q---------..M t L �,� --------- No. of'compartments_-..Z__________________Siz _ - Liquid depth__-', ___--------__CapacitY-_� Q i Disposal Field: Distance from nearest well -.-_Distance from foundation_ i ♦ ��________.Distance to nearest lot line _________._ ❑ w Number of lines__________ -___Lengfh of each line-/ _/� 1�--- Width of trench.a�- Rt--______.____.___ Type of filter material-/ QC�________Depth of filter materiaLl-�-___-____-.Total length_�W___--_-______________________ Seepage Pit: Distance to nearest well______----------------Distance from foundation-------------------.Distance to nearest lot line----------------- S_ ❑ Number of pits------ D ----------------Lining material----------------------.Size: Diameter----------------------- epth--------------------------------- v w ess ool: Distance from nearest well-----------------Distance from foundation------------------.Lining material-__----______-____------_--__--_____. �1 p - ❑ Size: Diameter- ------------------------- ---------Depth - ---------------- -------- ----------- -------Liquid Capacity------------ ---------------gals. At ( Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------- ------------ .0:!-- ❑ Distance to nearest lot line----------------- -------------------------------------------------- 6 l Remodeling and/or repairing describe}: - ----- *__ --R------------------------------------------------------------------------------------------- ----------------------------------------------------------- I --------------------------------------- ----------------------------------------------------••----------------------------------------------------------------------------------------------------------------------- I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. I �151_' !. '' � F ' Ic A------ -- -- -- ntra---- ------------------------(Owner and/or CoorI (Signed)------- ---- _ By. _ _ = = -- - -. (Plot plan, showing size of lot, location o� in relation to wells, buildings, etc., can 6e place on reverse side). ' f J FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY �---r`/ - � - DATE ( �= REVIEWEDBY------------------------------------------------ i - DATE------------------ BUILDINGPERMIT ISSUED----------------------------------------- --------------------• DATE---------------------------- -------- - - Alterations and/or recommendations:-------------------------- - ----------------- - ----------------�,„--------------------•------------------------------------------- ------------------------- ---------------- ----------------- ----------------------- I --------------- ---------------------- ----- -- - ---------- ---- ------------------ - •------------------------ . ------------------------ FINAL IN N � - �Q--- -------- ------ - - Date-------- --------- 7~I` ' 'r` ------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak street 124 Sycamore Street 205 West 9th street s # Stockton,California Lodi,California Manteca,California Tracy,California s