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r3 FOR OFFICE-USE r ------ -------------------- APPLICATION FOR SANITATION PERMIT Permit No. _.J....Y_ f:_✓. ------ (Complete in Duplicatel . ------------------------- ----- Expires --� --------------� This Permit 1 Year From Date Issued Date Issued y 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 rdinance No. 549. - JOB ADDRESS AND LOCATION_..._ -_ Q____- p�,,,A G = Owner's Name_-'---------------- --•��'- ""-•-------------------•--------------------------•----- ---------- ---------- Phone..................... Address...................a_-z, c_. J ------4:----------• ------------------------_-- -----------------------........................--•-------------- Contractor's Name---- l- .e S_... �2 l t-�+` `/��- �1�. �� j - 1 _.C_- ---........ Phone.........I......................... Installation will serve: Residence [� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __-E.-_ Number of bedrooms --� Number of baths --- --- Lot size ..... Water Supply: Public system E!Y�Community system ❑ Private ❑ Depth to Water Table J� ft. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9--Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [2k niew Construction: Yes []--No ❑ FHA/VA: Yes ❑ No ❑� TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep a q Distance from nearest well-----------------Distance from foundation ... No. of compartments--------------------------Size--------------------------------Liquid depth--•-----------------------Capacity Disposal Field: Distance from nearest well. -Distance from foundati n..-U-_____ g �;,. ._-_-Distance to nearest lot line-47--�__:_•_- Number of lines-- -------------------- Length of each fine------7D------------------Width of trench---•----- -2____•------- Type of filter material.....PO_'---__----Depth of filter material_-_f--`!______.•_.Tota! length------7A_ .....................•--_-- Seepage Pit: Distance to nearest well----7 -______Distance from fou dation.._ �..."Distance to nearest lot line---x1_____ \ Number of pits------- -------------Lining material.---__._...1........�Size: Diameter-_------ - ---3--�----.Depth--------------�-�'�-�-- -- -- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------lining material----------------------------------------- El Size: Diameter--------------------------------------Depth-------------- -- ----------.Liquid Capacity---•-•---------------------gals. - --------------------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building ❑ Distance to nearest lot line--------------_.----_---_-._.__---___--_---_. Remodeling and/or repairing (describe)---------------------- -- I hereby certify that I have prepared this Y/Joa d that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulatioin Local Health District. (Signed)-------------•-•----...----••------•-•------...-----• --•- -------------------------------•- -- - -- ------(Owner and/or Contractor) gY: ---- ----------(Title)-•-------------------------------------- ------- ------------- 9 p(Plot plan, showing size of lot, location syste , buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B ----- --- - - -- ---- ----------•--------------•----- DATE------ .�-'�"� ---------- i EVIEWED BY------_------------_---- ------- DATE BUILDING PERMIT ISSUED_____________•____-- ---------•---------------••------------------------- ------- DATE------ ------- Alterations and/or recommendations----------------_.- ------------ s"- F1NAL INSPECTION BY:------ --- ------ --`----Y`----- ---- Date--.------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Sweet 124 Sycamore Streett 205 West 9th street Stockton,California Tracy,California EB 9 REVISED 8-99 ZM 5-E1 ATLAS Lodi,California Manteca,California