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t FOR OFFICE USE: - - - - - -------- ---------- -------------------- ---- .---------- . _ -APPLICATION FOR` SANITATION PERMIT Permit No. r `r ---------------- -- ----------------------------------- (C"Plete•in Duplicate) -- --------------------- -- ..-- This Permit Expires 1 Year From Date Issued Date issued �d r _..:_ � 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. i ,r JOB ADDRESS AND LOCATION---------�5-�'2'--�--�-�-�,�,�I1�./DC��--- ---L^'-----�-----�-- ----------------�-�- Owrter's Name Re-^ez`i^r5----- - +zc`Ycc ------------------------------= --------�- - - ----------�-�--� --- --�--�-�- -�--: Phone---------------------. Address------------ -----•------------------------------------------------------------------------------------ ..-•------•--- 4. Contractor's Name �4-----------._ ----------------------- Phone----------------------------------- Installation ---- --------•---------Installation will serve: Residence T--A-partment House ❑ Commercial E] Trailer Court [I Motel ❑ Other ❑ Number of living units: __?___ Number of bedrooms,_._ Number of baths _ Lot size Water Supply:�Public system ❑ Community system ❑ Friva#e' epth to Weer Table l0_ ft Character of soil'to a depth of 3 feet- Sand ❑ • Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ -t Previous __- Application"Made: (If yes,date................... J No - New Construction: Yes [�P E] FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 4 f (No septic.tank or cesspool permitted if public sewer.is available within 200 feet.) Septic T Distance from nearest weft_ Distance from foundation___% __... Material ..__ .�-ve No. of compartments__________ Size _.�t�-1- ----•---L¢quid dept))-------- - ---,--- Capacity---_- { Disposal Fi d: Distance from nearest well-�- -------Distance.from foundation___- -- "-----Distance�to nearest lot line___ 5 .. " Number of lines.______-- ..... Length of each line__ _i �__ - _.Width.af trench._. '-.-syr Type of filter material47_6' .& --Depth of.filter material____---Z �`.-.--_Tofial length___-.__..Z_S� '_-------- ---------- Seepage Pit; Distance to nearest well-______________.. ��r. ._Disfiance from foundation---------------------Distance to nearest lot line__.________.__.__ ❑ ' Number of pits-,- Lining material---------------------- Size: Diameter-_----------,----------Depth-.-------------------------- -- Cesspool.:, Distance from nearest welt _______________Distance from foundation................... _ Lining mat vial___-._..._ < ---------------- � Size: Diameter. --- ----- --------^�'�Depth---------- - -- ------ -.Liquid-Capacity---------------...-------gals. Priv � � it y: Distance from- nearest well___________________ ----- _----- _------------Distance from nearest buildin - - i Gt ❑ Distance to nearest lot line .------------------------------------ -- - Remodeling and/or repairing (describe):_------_-- ----"---.- a--- --------------------------------------------------------------------------- ------------ ------ •---- ---------- --------------- --------------------------------- ---------------------------- -------------------------------------------------- - ----- -- - ----- -- - - - - - - - --------------------------------- --------------------------- 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)____ -_ - - - ------------ --•---------- -----------•----------- -- ----- {Oca ner and/or Contractor) 7 ) By:. --------------------- ----------------- - ---------- -------------------- i(�11 ---------------------------- ----- ---- --------------- �?` -- -----. ............... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse sine). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED,BY- - -------- REVIEWED BYDATE ll-�` G :�� -� ----------- -------------------- - - - = DATE BUILDING PERMIT ISSUED____ -._.-- .._.____'__ ' __. -- ----_ -- -.'----- ----------------------------- - ----------- DATE---� - --�--------- - Alterations and/or recommendations: ............ ----- -- --------- ------------ ------ ------ ------- ------------------ -------=-- t : ----------- ----- ----- FINAL INSPECTION+ BY:. tef SAN JOA UI Q N LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 369 West Oak Street a 124 Sycamore Street 205 West 9th Street Stockton,California : ' Lodi, California Manteca,California� Tracy,California E.H.9 2M 1-67 Vanguord Press +e- f