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FOR OFFICE USE: -k 4 1 M ----------- - ------- .x t. APPLICATION FOR SANITATION PERMIT Permit No. .. .__. .... ---------- ---------------------------------.-.-..---- (Complete-in Duplicate) ----------- ---- ----- --------- This Permit Expires 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. 1 This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATI N----h--- �--I-' -----cy411---` 4--------------------------------•----------------------- ------ .. , Owner's Name---- ....... ---�y-.' '=`a---------------------•-------•----- -- --- ------ -- -. Phone------------------------------------ Address............... te n- -------------------------------- -------------------------------------------------- -------=----------------------------.---------------------------------------------•---- Contractor's Namezc! 3,7- -s. - Phone 'I -------------------------------- ------- ----------------- Installation will serve: Residence [B'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __f--__ Number of bedrooms --_ Number of baths J____ Lot size --- ------------------------ x Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table -...__ _ ft I 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 1!r New Construction: Yes ❑ No FHA/VA: Yes ❑ No R— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tara Distance from nearest well-----------------Distance from foundation--------------------Material ----------------- .____....____-.-.----.---_.._. \ ' No. of compartments--------------------------Size----------------- Liquid depth--------- ------- ------.Capacity----------------- --- Disposal. Fiell y Distance from nearest well- _-----------Distance from foundation__lt?---------------Distance to nearest lot line---3� ._______. i � Gl Number of lines.-----I---------------------------Length of each line-G4_`-------------------.Width of trench-._.Z-11--_--- ---------------- Type of filter material.---!?04TA--__Depth of filter material__/-9'-*_---____-Total length__.4 ----------------------------------- Seepage - _________._------_-.____ Seepage Pit: Distance to nearest well____"-_-------------Distance from foundations--_f-_--_.-__-_- Distance to nearest lot line -_---.- Number of pits--- -I------------.--Lining material_:RP(�f- --_ Size: Diameter---3!3-.'----------Dept h.....Z 5-------------------- I i Cesspool: Distance from nearest well ----------------Distance from foundation----------------- --Lining material _._.......------...____.-_-_--------. ❑ Size: Diameter- -- ---- -- ----- ---- - --------Depth------ ------------------------- - -----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well................------------------ ----.---------Distance from nearest building____-.__-__-----__________-..--_ ❑ Distance to nearest lot line --------------------- -----------I------------------------------------ ----------------------------------------- ------------------------- Remodeling and/or repairing (describe:--. (�" `' f`�r'""t cs ` '�----- --'�=i'�.[-----V -' `' 'o'~` =' --------•-------------•---------------------------------- --------------------- --------------------------------------------------------------------------------------- -------------------••------------------------ ------ --- ------•--------------------------------------------•------------------------------ --------------------r------- ------------------------------------ ---------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law�ss,, and rules and regulations of the San Joaquin Local Health District. (Signed) p- -- --- - ------ ---- ---------------------- ----- ----- ----------------•--- ---------------------- ....(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-19-t....... - -------------- ------- ------------------- ------------------ DATE_ REVIEWEDBY--------------------- --------------------- ------------ -------------------- ---------- ----------------------------------- DATE----- ----------------------------------------------------- BUILDINGPERMIT ISSUED-------- -- --------------------- -------------------------------------------------------- ------. -- DATE...--------------------------------------------------------- Alterationsand/or recommendations:.--- --- ------ ------------ ------ -------- ---- ------------------------------------------•--------------------•-----------•--•---------------------------- ---•-----•----------- ----------- ------- ------------------------------ - ------------------------ ----------------------------------- ----------- -- ------- ----------------------------------------------- ------------ ------ --------- ------------------- ---------------------------- - ------------------------------ -------- - --------- ---- ----------------- ---------- FINAL INSPECTION BY: .tet - -------- ------------ -- -------- Date_----- ------ ------------------------ A JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca, California Tracy,California E.H.9 2M 1-67 VongUard Press