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l'-UROFFICE USE: ,3-- 457- � 1 ------- ------------------ -- -----_--.-___.-- ._ ..� APPLICATION FOR SANITATION PERMIT Permit No. - .......--_...-_.--.- // -3_� (Complete in Duplicate) -�` ----- - -- --.--- This Permit Expires 1 Year From Date Issued Date Issued t ----------------- = 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 complia 6ce with County Ordinance No. 549. JOB ADDRESS AND LOCATION-.'.__--.�--_3.1/------ �, 00 -- - ----• ----------- - ------------------- Owner's Name_----. _-__-- � -- - ---- ----------------------------- ---- --------------------------- --------------- Phone_-ZVI,/ _ 4:!3 Address------ ----------------- r Contractor's Name -. Phone ----------------- ------------ - —W— Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court e Mote! ❑ Other ❑ Number of living units: __- - Number of bedrooms -------- Number of baths -------- Lot size --- DQ_ _---. �- -- X�-�,a -------- ------------•- Water Supply: Pubiic'system �ommunity system [❑ Private ❑ Depth to Water Table S7J ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe r�Hardpan ❑ Previous Application Made: (If yes,dote-�_9-.�0,./--,_-_} No ❑ New Construction: Yes ❑ No Ug�FHA/VA: Yes ❑ No ❑ l TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` Taak: Distance from n1 earest well-----------------Distance from foundation---------- ------_Material_-_- ----- ---------------------------- No. of compartments----- ------- ------------Size.----- ----- -- ----.Liquid depth---------------- -----Capacity------------- oq�Disposal Field: Distance from nearest well- -G_K.Qr-Distance from foundation_ " --.a-----._---Distance to nearest lot Number of lines_!_-/__----- Length of each line-_-_a_C9_!-___.__-__.Width of trench-._--.___ 1 Type of filter material_s�,t_ Llc� � ---_Depth of filter material.----��_"-----Total_ length-----------------:------- ----.---- Seepage Pit: Distance to nearestwell--� Il - Q(---Distance j,,rgm foundation---,Q-`_---_,.Distance to nearest lot line-___5- 4 Number of pits___---_ __---___--_Lining material_--�_�.dL _ De _Size: Diameter Depth a- -------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------- __.-------Lining material-------------------- R ' ❑ Size: Diameter-------------------------------------Depth--------------:---------- ------- - ------ Liquid Capacity gals. Privy: Distance from nearest well---------------------------------------------- -Distance from nearest buiidin ❑ Distance to nearest lot line---------------------------------------------------------- Remodeling and/or repairing (describe):---__.-._.-- l ------------------------------------------------------------ -------------------------------------------- ----------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- ------ - - - ----- ----------- I hereby certify that I have prepared this application and that the work will be done in accordance w-ith--San--J-oaqu- - - ---in County- ordinances, St a laws and rules and r gulations of the San Joaquin Local Health District. (Signed)-------- -- --- ------ ------ ,,o ------------- ------------- "�-------'--- --- Owner and/or Contractor) By:------------------------------------------- I--- ` - ----------- ___ _ - ---------(rile)--- -(Plot plan, showing size of lot, location of system in relation to ells, buildings, etc., can be placed on reverse side). y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- -»✓ DATE REVIEWED BY------------ --------------- ! -- - - ----- ----- ---------------------------------------------------------------------- DATE-- BUILDING PERMIT ISSUED --'----------------------------- ------ DATE ------------------------------- Alterations and/or recommendations:— ---------------- --------------------------------------------------------------- ---------------------------------•---- ------ ------------ --- ------------------------------ - ----------------------------------------------------- ----- --------------- FINAL INSPECTION BY:...- ./�__--- � ------------- ------- Date-----------------�/��---------- ----------- ------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Str`6eT 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.a-C a.