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OFFICE USE: 5 -------=---- - r= _ ----------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . ----------- - ---------------------- ----------------- - (Complete in Duplicate) This Permit Expires i 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. I This application"is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION____'Z___�`_4 jam. +�' �1 --------------------------------------------------------------------------------- iOwner's Name. -C�----------Q!--- ------------------ ------- ---. - Phone._..---------------•----------•--- R Address-------2_- Contractors Name------- '��-r 1c't. s -C:__.: i?1_i!7. ------ ��.'�_.V. -. Phone.-----------•------------------•- Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: A---_ Number of bedrooms :5__ Number of baths ....i--- Lot size ---�17.......�__1__��`________________-___ Water Supply: Public system ❑ Community system ❑ Private'Ej Depth to Water Table 6--S ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe N Hardpan ❑ ' Previous Application Made: (If yes,date._--.__--._-..---) No [, New Construction: Yes 1. 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---;5 :_____Distance from foundation------1-C-___._. No. of compartments------- -------------Size-?-------_- _Liquid depth.-_.V__].4-------------Capacity____. - -- Disposal Field: Distance from-nearest well _-~` ...._.Distance from foundation_____ _ �..�:.--------.Distance #o_.nearest lot line___�_'�___1___.. � J ❑� Number of lines__--____ ....__._______. ____Length of each line------- ._ r..__._._Width of trench.___�� i ______.___.•._ / ' d Type of filter ma#erial_S- _N_V0_Q"-_Depth of filter material. __ Total length--------1--,7 ----------------- r Seepage Pit-. Distance to nearest well------ from foundation---._(_--------Distance to nearest lot line______ X + " Number of pits-----!2:- _..____--Lining materialDiameter._.4-- Depth---_LC_._................... 1 Cesspool: Distance from nearest well-------------_---Distance from foundation--------------------Lining material---___-__-._---_---____._.__-_---__ ❑ Size: Diameter----_----------------------------•....Depth.----------------------------- ---------------------Liquid Capacity---------------------- gals. Privy: Distance from nearest well_____________________________ __-_.__._Distance from nearest buiiding._________.____-__.-______.__...-..____. [f Distance to nearest:lot line--- Remodeling and/or repairing (describe:---- --- ------------- - -------------------------------------------------------------------•-----------------=------------------------------------- ---------------------------------------------------------------------------------------------------------------------------•--------------•-------------------- ----------------------------•--------------------------- ---- --------------------------------------------------------------------------------------------------------------------------- ------------------------------------------ -------------------- ---------------------------- I hereby certify that I have prepared this application and that th work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San-Joaquin Local Health District. (Si ned `. 9 )---- (Owner and/or Contract �- Y• --- r =' --------------------- 0 or _ {Title)-_ (Plot plan, showing size of lot, location of system to relation to}wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___-.Cj_,_ ------------- DATE---S- -�-fir- �� ------------------------------------------------ -------------- - REVIEWED BY------------------------------- - DATE_ BUILDING PERMIT ISSUED--------------- - DATE Altera#ions ar>~d/or recom ndations: -----s -_-�_- % _-- -- -- -c �xti��-r�T-z-t_' ---- ---------`- ----------------------------t----, � Com ------------------------------------- ------------------ -- --=--------------------------- ----------------------------- -------- --------------------------------------------------------------------- -------- ----------------------------- ------------ FINAL INSPECTION BY:_... .__.. - w � .. / ��f - - Date ------------------ r S _N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazeltan Ave. T 300 est Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California L di,California Manteca,California Tracy,California i