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FOR OFFICE USE:' - s.✓ 4 ,, v --------- =- ------------------------------------------- APPLICATION FIR SANITATION PERMIT ,Permit No. .,-:.;? -�..0. ------:-- --- --- -- (Cornplefe in Duplicate) Date-Issued --�----�--�� - ___.._.________________._..._-.___.._._.__._.__..___._- This Permit Expires I Year From Date Issued - t Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work Iherein described. This application is made in compliance with County Ordinance No. S49. „ JOB ADDRESS AD LOCA ION -------------- ._ �� Owner's Name------- - &------- - -- - ----------------------`---r!:------------- ------------------ - --------------- -- Phone_?! -/_ Address -{ -------------- - ---- -- ------------- e Contractor's Name -------------------- - --- � � •�' .- .r Phone__ C 1� - -- ! -�� 3/� j� Installation will serve: Residence ❑ Apartment House ❑ Commercial e Trailer Cur El Motel F1 Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths_- of size ----..- __________________________-- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Ta1ble-,5----- ft. Character of soil to a depth of.3,feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ 'Clay•❑" Adobe Hardpan ❑ t Previous Application Made: (If.yes,date__'`---------------..) No New Construction: Yes EB`�o ❑ FHA/VA: Yes ❑ No ❑ .._. TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from'nearest well--__________Distance from foundation--- ________---.Material__F _______________________ ___________ _ 1 No. of compartments_-_- --_____.____._Size ��kr'�S r!� _f_.Liquid depth_______f_-______._-Capeci#y. � Disposal Field: Distance from neares/t welf;re? -e--Distance from foundation___._..........Distance to nearest lot line............ 9-11 Number of`tines______!_-___..._ Length of each line--- .'_._.._--_-_____.Width of trench.-------7_�_r--___�.__--_-. Type of filter material__.5c - 4e Depth of filter maferial-_,/_9--_----_ Total length-----------------------�v------------ C' - --__._ C[�' ,� Seepage Pit: Distance to, nearest well-/! "?4-P-)__Distanc9_Jxom foundation_F _______-_.Distance to nearest lot line.,.-.-._--.-_ � Number of piis....__/---------- Lining material _t/G_�C'__Size: Diameter._.�.3__��_____Depth_______-__ _............. f --__._ Cesspool: Distance `from nearest we}i------------- Distance from foundation___-----------------Lining material-______-..__..__._-..-----_-.________- [❑ Size: Diameter--------------------------------------Depth--------------- I----------------------------------Liquid Capacity-_!----------------------ga€s. (� Privy: Distance from nearest well-_______________________________________________Distance from nearest building-------------._________------_____------ ❑ Distance to nearest lot Iine----------------------- ---------- ------------------------------------------------------------------------------ --------- -------- ------ Remodeling and/or repairing (describe)--------------- ----- --------------------------------------------------•----------- -------------------------- - �L_ f ----------- -----------•--------------------------------------------------------------------------------------------------------------------------------- --------- ------------------------------------------------- T ------------------------------------------------------------------------------------------------------------•-•-------------------------------------------- ------------------------------------------------------------- ------------------------------------ ---------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ 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 re lations of the San Joa uin Local Health District. (Signed) ' �- Owner and/or Contractor B ......................Titl .... Y• = - { e) (Plot plan, showing size of lot, location of system in relat to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY • ; APPLICATION ACCEPTED BY------ x� �"` ------------ - - -- - � - -- -- , - - - --- DATE_ --- ------9 ---------------- - REVIEWEDBY---- - ------------------------------------- L-------------------- ------------------------------------------------------ ---- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------_----------- -----------------------------------•--------------------------------------- DATE---------------------------------------------- ----------- -- Alterations and/or recommendations------------------------------------------------ -----------•------------------------------------------------------------------•------------------------------- -----------------------------------------------------------------------------------------=------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------- ------------------------------------------------------------------------------------------------..------------------------------ ------- ---------------------•--- ---------------- ---------- --------- --- ----------- ------------ ----- ----------------------------------------------------------------------------------------------------------------------------- ------ ------------------------------------------------------------------------------------------------------------- -•------- ------ -------------------------------- ----------------------------------------------------------- , FINAL INSPECTION BY:.............. ,,<- C/ --------- Date--- ------------- ...... ...'.... ------- ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca, California Tracy,California F.P.C u.