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FOR OFFICE USE: �fJ w f- R �r VAX-------- ------- / . __-_-__ ,___.. ._ti-----------------f - 9�. APPLICATION FOR SANITATION PERMIT Permit No. - f_%� _.� --------------------------------------------------- -- -- (Complete in Duplicate) Date Issued .lt -_._----.--.-_................. --- -- ------ ----- 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 Ordinancq,No. 549. JOB ADDRESS AND LOCATION._V/-Q----- -------------------------------------------------------------------------------------- Owner's Name------- ---------------------------- --------------------------------------- ---------------------- Phone-----•-----•------------------•- Address. l °�Q- ---- ---- ------------------------------------------------------------------------ --------------------------------------------- ,;P- Contractor's Name------- a �----- -------- --- ------ Phone-.-•-------•-------------------- - Installation will serve: Residence �Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -./. Number of bedrooms S.- Number of baths --1._ Lot size 44?.,�-� - --------------_...__._.-_.-- Water Supply: Public system Community system El Private ❑ Depth to Water Table 's ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g?O' lardpan ❑� Previous Application Made: {lf yes,date-_-----------------) No 2' New Construction: Yes ❑ No [dam 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----------------------R Disposal Field: Distance from nearest well.-:___ -------Distance from foundation.._.e! --r..--Distance to nearest lot line.-46.--.----- ' f _--.------ Length of each line--_-_Zl: ._`---------------Width of trench-9----------------------------- �!�� '`� dumber of lines-------- ----- - Type of filter material.1�i r_.Depth of filter material---��---..----Total length....- --------------------------- s � Seepage Pit: Distance to nearest well----------------.---Distance from foundation---/-49-_----. Distance to nearest lot line-4. ......... Number of pits-....e..............Lining material---/�t?C -'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------------------------------------------ r-71 ---.-_--.__---------- .__-.-------.❑ Distance to nearest lot line-------------------------- ------------------------------------------------------------------ rt�Remod lin aryl/or epairing [describe): ---- --- ' r � �/�2( -------- ----------•----------------------- ----------------------- ��---F'�'--r- -�-�.--- � �s�r-„�<�-'--�.c-.cam-.-.:cam -�-..�rr_��.1•� -- -- -��.-��s ��--- I here certify that I have prepared this application and that the woi don in accordance with San Joaquin County f ordinances, State laws, and rules and/reeggu�latiions�of the San Joaquin Local Health District. (Signed)------------------ �-% � /c.—_ � �.------------------------ (mor Contractor) By:---------------------------------------------------------------------` ---------� --------------------------(Title)----f es//$ --------------------------------- (Plot ----------------- ---------- (Plot plan, showing size of lot, location of system relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY , APPLICATION ACCEPTED BY----- ------ --------------- ---------------------------------------------- DATE------- .a, REVIEWEDBY------------------------------------------ -- ----------------------------------------------------------- DATE----------------------- BUILDINGPERMIT ISSUED----------------- --------------------------------------•-----–-------------------------------------- DATE------------------------------------------------------- ---- Iteraf ns n or reco mendations- -t ---- ---------------------- ---------------------- ---------- /0 -- /a f ' Ql --------�------- --- ---- --- --------------------------------------------------------------- ---- - ---- -- ------------------ I FINAL INSPECTION BY:- ” Date- 1� =.' 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 6.P.CG.