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FOR OFFICE USE: �s f�------ ---------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------ / ------ -------- --- --------------- --- --------------- (Complete in Duplicate) Date Issued ___ - ----------------------------------------------..___.`.__ 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. �� 051 /� /'� /� --------------- ------------------ JOB ADDRESS AND LOCATI N..___._____-_- _ __ Owner's Name--------------------- I-�I---... -------- Phone -- -- f� ''S'l..,Gi i122 I!r/ 'Address e••---------------- --------------•--- ------------------------------------- Contractor's Name-------------- ------------- ------------------------ ---------------- Phone...7 _fit_ 'Q_7 I Installation will serve: Residence 2--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ F Number of living units: __ _- Number of bedrooms ___ _ Number of baths _J--- Lot size----;Z ---- ------------ 11 Water Supply: Public system Community system ❑ Frivate ❑ Depth to Water Table _.-.---- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [Clay ❑ Adobe❑ Hardpan 0 3 Previous Application Made: (If yes,date--------------------) No •New Construction: Yes ❑ No [S HA/VA: Yes ❑ No [3-- f 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--------------I-----Material ...__________---__.___.._________.__________- 0 No. of compartments- ------ ------------size--------------------------------Liquid dep.4h--------------------------Capacity-------------- -------- Disposal Field: Distance from nearest well---------- ___---Distance from foundation--------------:-___.Distance to nearest lot line----------------- I Nurnber:of lines----------------------------- Length`of each line Width of trench Type of filter material-------------------------Depth of filter material-._.____________-..__Total length___-_-_._________._________________..__.. Seepage Pit: Distance to nearest well-_-__-_-.__._____Distance fro foundation----ee-___-._Mstan e to nearest lot lm Number of pits-------/___.______Lining material___S, ',% -size: Diameter._I-1-4yr--------Depth __.._ Cesspool: Distance from nearest well-----------------Distance from foundation----------.----_----.Lining material------------------- V-1 l F] Size: Diameter--------------------------- ----------Depth-- ----- ----------------------- --- ------- -----Liquid Capacity---------- -----------------gals. - . I N Privy: Distance from nearest well-------------------------------------------------Distance from nearest bui4&ng----------------------------------------- 1 ❑ Distance to nearest lot line l- - --------- --------- --------------- -- ----------------- ----------------------------- -- ------------------------------- Remodeling ------Remodeling and/or repairing (de`scribe):_..___.-- 5- - --------------- ------------- ------=brag- .�. �----- i d f . f I _ 1it ----------------------'--------- ----------------------------- ------------------------------------------------'----------------------------------------------------------'-------------------------------------------- ---- - I hereby certify that I have prepared this application and that the work will be done .in accordance with San Joaquin County ordinances, State I rules and regulations of the San Joaquin Local Health District. (Signed)--------------------- - r1.cSl7yw rand/or Contractor)-- T Title < -------- -------- By:------------- -------- --------- - - --------- - ------------------------------------- (Title) (Plot plan, showing size of�1�ot, locafiio- fsystem in relation to wells, buildings, etc., can be placed on reverse side). 1- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- - -- ----- ------ ------- DATE - �1 � ---------------------- REVIEWEDBY--------------I--------------------- ----------------- ---------------------- --------------------------------------------- DATE----------------------------------- ------------------ ---- BUILDINGPERMIT ISSUED--------------------------- j)--------------------------- -------------------------------- - ATE---- -----------------------=----------------------------- / Alterations and/or recommendations:----- �L`�l C<__c.... >r- z- - ---- } f_ ______________________________________________________ k l _______________________________------- --------------------- ------ ___ ________________ ----_ ______________-_-.-..._______..-____..-_.---_._______.__--___.._.--_..-.-------_._.__.__.___.______._.._--_ ______________________________________________________________________________________ ---------------------------- _ FINAL INSPECTION BY:.....� -------- - ----- -- -------- --- ----- Date---- � � SAN JOAQUIN LOCAL HEALTH DISTRICT I 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.C O.