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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ... :�. . .,� ---- -- ------------------------ (Complete in Duplicate) Date Issued ...-11./�,V(/ .... ---------- ---------------------------------------- This Permit Expires 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. A'c -Lf Z 3st{ &c'. (-ac7M,0 r4 t_ 2a t5, JOB ADDRESS AN[ LOCATION '�� _ ..�- ;tom � ---------- ? ��+ -. Owner's Name-- / ..G ? - -�-r �.L / �_. F-�r -� Phone. Address................� ,c...�_•a_.r-fes -5--7-Y Cz ----------------------------------------- Contractor's Name-.. !�- '.!�t � :t Tt` s. iLA?Y---- hone..---------•---•-•------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1---- Number of bedrooms .:.Z- Number of baths Z-.-. Lot size -----a�' 1.Pe• z-------------------------- Water Supply: Public system ❑ Community system ElPrivate Depth to,Water Table -------- ft. O 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 ❑ 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..-...-.-....-......-__.___-.--.-.--------------. ❑ No. of compartments--------------------------Size--------------------------- ---Liquid depth--------- ----------------Capacity------------ -------• v7 Dispos i Field: Distance from nearestwell... ,____Distance from foundation___.../0_r---.Distance to nearest lot line..--- - Number of lines--------------t._.___ Length of each line--------e .. A- -_------------Width of trench.�L' a�.- .............__; Type of filter material-j—JU_ ...._Depth of filter material--------f.�-------Total length------------ -------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line- .----- ❑ Number of pits---------------------Lining material--------------.-------.Size: Diameter-----------------------Dept h-------------------------------.. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------______--__-------.-.--. ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building____---.-----------------_--------------. ❑ Distance to nearest lot line------------ ------------------------------------------------•-------------------------------------- Remodeling and/or repairing (describe ----- ------------------------------------------------------- •_ -. -- ----- ------------------------------------------------------------------------------------------------ -- - --------------- --------- -------------------------------- -----------------•- -----------------------------------------------------------•--------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------- -- ----------------------------------- -------------------------------------------------------------- ��- 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 the San Joaquin Local Health District. (Signed)_ ner-ark/or Contractor) ---------------- --- --------------------------� .-F _...._. .<--------------...--.---------.-....._-------. ..and By----------- ., ..e t --- ------- - --- - -----Q-----------------------------------------(Title)----------------------------- ------ -- - - --._---------- (Plot plan, showing size of lot, location of syste in relatiof�ra�-o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------------------------------------------- DATE--- -� --``--------------------------------- REVIEWEDBY------------------------ ------------ ---------------------------------------------------------------------------------------- DATE---- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------- Alterationsand/or recommendations:------------------------ ------------- -------------•---• ------- ----------------- !N-----•--•-------•----------------------------•------------------- N ----------------------------------------------------•------•----- -•------------------- ------------------------------- -------------------------------------------------------------------------• -------------------------- -------------I----------------------------------------------------------- -------------------------------------------------------------•---------------------------------- ------------------------------- -----------------------------•----------•--•--------------------•--------------------------------------------------- FINAL INSPECTION ------------------ --- Date- -------- ------------------------------ --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.ffaxeltan Ave. 300 West Oak Street , 124 Sycamore Street. 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 4 REV15Eo a-54 3M 3-'63 F.P.CC. ,