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FOR OFFICE USE: _ Ij APPLICATION FOR SANITATION PERMIT Permit No./yrs- — ___-_ (Complete in Duplicate) r Date _______ I------------------------------- 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. ` JOB ADDRESS AND LOCATION.-t_2 '?-7-2.- ------------------------------------------------------------- - ----------- Owner's Name----- .P �------- l------- Phone---------------------- - ---- --- ------------------------------------------------------------------------ ------------- AddressPsQ _ ----------------------------------------------- -------------------------------------.._..--------•-•- Contractor's Name_________4 � _T _-__-____. Phone__________________________ " Installation will serve: Residence � Apartment House ❑ Commercial.-E] Trailer Court-[] Motel ❑ Other ❑ Number of living units: ---I---- Number of bedrooms _�Z_- Number of baths __ --- Lot size ___- --________________________________..____ Water Supply: Public system ❑ Community system � Private ❑ Depth to Water Table 4�-P 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 [� New Construction: Yes ❑ No a' FHA/VA: Yes ❑ No 0— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if`public sewer is available within 200 feet.) �~ Septic ank: .1 Distance from nearest welL_�-___._______-Distance from foundation--------------------Material-------------------------------------............ 17 . No. of compartments---------- _ ----------Size-_------------------------ -----Liquid depth---------- --------Capacity----------------------- n Disposal Field: Distance from nearest well.ff_ '__.._Distance from foundation__iQ_-___..____.Distance to nearest lot line____?_____ Number of lines-__.__I---------------------------Len th of each line___.-- C` a Width of trench-----Zf-------------------- Type of filter material--�Z!_f- IC - --_---_--Depth of filter material--/* __ _ _ ______ _._Total length_____ _ __ ___________________ Seepage Pit: Distance to nearest ............Distance from foundation-_/ .........Distance to nearest lot line--- Number _VNumber of pifs_.1-----------------Lining materia ----Size: Diameter-_. ..__..-___Depth__.7S"-..........__------ Cesspool: _Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material__._____________.__.____._____.______- 'N [❑ Size: Diameter--------------------------------------Depth------------------------------- - - ----------------Liquid Capacity-...-----------------------gals. Privy: Distance from nearest well-...________.____.__---------- --------------Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line------------------------------------------------------------------------------------------------------------------------------- ---------- - Remodeling and/or repairing f describe)------------------------------------------------------------------------------------ ----------------- ------------------- ----------------------------• ---------------------- -----------------------•--------------------•---------------------------------------------------------------•------------------------------------------------------------ -------------- ----- ------- ----- ------------------- ---------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St to laws, and ru s nd egulations of the San Joaquin Local Health District. -` C f � I (Signed)---- -------------------------- - ------------------------------- ----------------------- ------------------------------------------(Owner 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- c �- DATE !/f yy��-- REVIEWEDBY--------------------------------------------------------------- - --------------------- DATE--------------------------------•--------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------_------------------- ----------------- DATE----- ---- -------------- +. Alterati ns and or recommendations:---- t 3 G-f,--------V------`-`L-------- --- �.�' nuc cwt--`'"--'=`_- fns-- r s`--------- -- -- - ----------------- ---------- ---- 1 J.��'0 ' ----------- --r'r_:-1.h}----- -._ 1' t s-• t _ car ----- r a a lh- ------ -------------- �-- --------- - - - -amu --=------ - - ------- ----- - - # � �- � ------------ -------- ----------------------------------- ------ ----------- --- --------------------------- ---- ------------------------------------------------------------------------------------ FINAL INSPECTION BY:. ;. . . = -----------------4------- Date1--0111--1154- AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.