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tUKUrrIC-t U�)t: -------------- ----------------------------I-- --------- ------------------ - ---------_____--_-_---___--__ -------------- APPLICATION FOR SANITATION PERMIT Permit No. �2 l ----------------------- --- ------------ --- ----------- (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. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_sap---lv-f�,f�o----- -------- ----•-------------�c�-_rra�---�- -- - - - -- ---r�----`-�-`----�---..�.� Owner's Name (4)a_1� rte ------ ------------ -- --- -Phone.. - . -----••---•------------------ ----- Address_- 3.5 ---- ---•------------------- O S I —0 Z-e—2g Contractor's Name -----��rrk --=------ ------ Phone----------------------------------- Installation will serve: Residence// Apartment House E] Commercial E❑ Trailer Court E] Motel C] Other E]Number of living units: ..../.- Number of bedrooms __Number of baths --- Lot size ---- ----- _ __--- Water Supply: Public system ❑ Community system ❑ PrivateDepth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---------.----.._--) No ❑ 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 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation------------------- Material---------- -------------- r ❑ No. of compartments-------------- -----------Size--------------------------------Liquid depth-------------------------Capacity---------------- ------ Dispos Field: Distance from nearest wel€__� -/-.--_Distance from foundation_____-!Q-.'____-Distance to nearest lot line_.5........... Number of �]lines---------r____-------------------Length of each line-----1-_C]_-cl-_..___---._.Width of trench----°�- -------------------- Type of filter material-------5__�--------Depth of filter material____-f_�'_.._`____Total length----/-I.-P-A---------------------------- Seepage Pit: Distance to nearest well______________-_-____Distance from foundation___.__..._-_._--__-.Distance to nearest lot line-----------._-.__ n ❑ Number of pits------------------ ---Lining material----------.-----------Size: Diameter-----------------------Depth--------------------------------_ 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----------------------------------- F1 -___-_-___--_-_-_-_ -__ _- - ❑ Distance to nearest lot line-- - -------------------------- Remodeling ----------------------Remodeling and/or repairing (describe):------- ----•- •----------------------- - Q—GP -� ------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 rule and regulations of the San Joaquin Local Health District. (Signed) -- -•- --------- d/or Contractor] By: ---------- ------------ ------ ----- ------------- ----------------- --- -----(rifle)-------------------- ---------- ----------------- ------------- (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- - - -- - DATE r REVIEWEDBY------ ---------------------------------- ------------------------------------------------------------------------------ DATE BUILDING PERMITISSUED---------------------------------------------------------------------------------------------------- DATE Alterations and/or recommendations:---------- ------------------------------------------------------------------------------------------------------------------•----------------- --------------------------•------------------------------------------------ ------- --------------------------------•--------------------------- ---------------------- ---------------------------------- •--------------- 3 t ------------------------- -- ------------------------------- --------------------------------I------ ------------------------------------------------ ----------------------------------r.................................... ---------------- ------- ---------------------------- ---------------------------------------------------------------------r...................................... FINAL fNSPECTION BY: Z-2,2� __ Date-- - ` SAN 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 F.P.Q p,