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r '"FOR OFFICE USE: -- --- ---------------------- ------------------------------- -- APPLICATION FOR SANITATION PERMIT Permit No. .��--- ............. in in Duplicate) Date Issued -- --- - - (Complete -_lf__ This Permit Ex ires 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. 1}�fj : t` �f- f�SD Ol It-1 Ss 57'- 9469,e-Tz� #�-A JOB ADDRESS AND LOCATION--S��._ _cry---- -- P _ �- ---..��-__-`�-- -- -1 f�---. ' ------------------------ Owner's Name _ ! --`- - Phone ----------- ------------ F _ ___ __ _____ ___________ ` Address- ------- pJ ------ 7 ---- - ----------------- Contractor's Name----.- 6,01 �'_'_' - �---- ._ Phone---------------•--------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ __ Number of bedrooms -_ Number of baths _f_-- Lot size ---------------------------- Water Supply: Public system E] Community system E] Private ["De-pth to Water Tab)e . -- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan a Previous Application Made: (If yes,date____________________) No R20'* New Construction; Yes ❑ No [ FHA/VA: Yes ❑ No TYPE OF-INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 244 feet.) Septic Tank- Distance from nearest well_________________Distance from foundation--------------------Material-----------------------.------------------------ /U I _._______--__._.__.._/CI S <` No. of compartments--=--- ---------.--- Size----------------------:-- -- ---Liquid dept-------------------------.Capacity-----------------------� �1 Disposal Fief: Distance from nearest well--o.__op...._Distance from foundation___�_�� ___..__Distance to nearest loot liners _. .__.+ •' / �' of lines______°______ Length of each line--/"--`----------- of french.__._------------------------- Number � y -� , Type of filter materia��ix Depth of filter material-- ___--.----Total length_.�1�'e9____ ____________________ Seepage Pit: Distance to nearest well____-------------_----Distance from foundation------...-__....___.Distance to nearest lot line______..______.._ ❑ Number of pits----------------------Lining material--------_-..-.-----...Size: Diameter----.--.---------.-.---Depth----------------------- I � ' n Cesspool: Distance from nearest welL______________Distance from foundation--------------------Lining material_______________________________ ❑ by Size: Diameter------ ------------------- ---- Deoth-------- ------------------------------- ------Liquid Capacity- -------------------------gals. Privy: Distance from nearest well______________k___._______._____________..__._Distance from nearest building--------------.-__________----- --_-I ❑ Distance to nearest lot line.- ----------------------------------------------------------------------- -------------------------=--------- ------------ Remodeling -------Remodeling and/or repairing (describe): r -+ I ---------------------------------------------------------------- ------------- --------------------------------------------------------------- ---------------------------------------------------- Iy� ------------------- ------ ----------------------------------------------------------------- ---------------- ------------------------------------------------------------------------------------------------------ - -------------------------- --------------------------------------------------------•------------•--------------------------------------------------- ------------------------------------------------------- .----. t 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, and rules and regulations of tate San Joaquin Local Health District. } . (Signed)--------------------- fCr — t � r �/or Contractor) - -------------- By:-------------------------------------------- -� -----------------------------(Title) ---+ -------- --- -------- --------- (Plot plan, showing size of lot, locatiouildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY = APPLICATION ACCEPTED BY. ... t1 - S C'` t1 - �`°�r ------------- DATE REVIEWED BY------------------------- - - ---- DATE--------- - BUILDING PERMIT ISSUED--- --------------------------------------------------------------------------------------._ DATE------------------------------------------------------------- Alterations and/or recommendations:------- ------ -- --- ----- -- - ----------------=---------------------------------------------------- ------------------------- ------- -- ------------ ------------------ -------------------------------------------------- ------------------------------------------------------------------ ------------------------------------------ ------------------------------------------------------- --------------------------------------------------------------------------------- -------------------------- ------- --------------------------------- ---------------------•-------------------------------------------------------------- ----------------------------- ------------------------------------------------------- --- ------------- --------------------- ------------------------------------------------- ----- ------------------------------------------------------------------------------------------ ---------------------- FINAL INSPECTION BY:..- � ............................ Date---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazollon Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California