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FOR OFFICE USE: r ------------------------------- APPLICATION APPLICATION FOR SANITATION PERMIT Permit No. ------ --------------------------------------------- (Complete in Duplicate) f� Date Issued .__�1_1..�.5- This Permit Expires 1 Year From Date Issued K 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. S49. �JJOB ADDRESS AND LOCATION----- - -- 5------•------------------------------•------------------- .Owners Name----------------------------------- �- ------------ � ------ --_.- Phone__/S�_a_ - Address-----------------------------------------------------61� 011"!�------- ----------------- -------- - - --------------------------------------------------------- Contractor's Name-----=---------------------- - - ----------- ----------•-------------- ----------------- Installation ---------------Installation will serve: ResidenceApartment House ❑ Commercial E] Trailer Court ❑ Motel ❑ Other L] t Number of living units: Number of bedrooms -_ Number of baths _f__-_ Lot size __._t �__K__j_�o__________ ------------- Water Supply: Public system El Community system ❑ Private Depth to Water Tableft. } t ``Character of soil to a depth of 3 feet: . Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam W Clay ❑ Adobe ❑ Hardpan ❑ aPievious Application Made: (If yes,date------------------------------ No New Construction: Yes ❑ Nog_ FHA/VA: Yes ❑ No,V 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----------------------- ' rl _ Disposal Field: Distance from nearest well... .............Distance from foundation___/.�_-______.Distance to nearest lot line--- _._____ Number of lines___________________ __ ____________Length of each line__�Q-�_ZS'.2S �Nidth of trenchy--_------------------ Type of filter material_-- - __ - - -_ _Depth of filter material----/4c_____..____.Total length--------1_&TT:-__r-------------------- R h Seepage Pit: Distance to nearest well------ ---------------Distance from foundation-----___------__._.Distance to nearest lot line-------.____-___ r Number of pits.------`---------------Lining material-----------------------Size: Diameter.-----.---------------Deptn_.------------------------------- �' 4 Cesspool: Distance from nearest well_________________Distance from foundation-----.-.----__--,_L'ining material__-.__----__----_-________-__--.__-.-. ❑ Size: Diameter--- = ----- - --------------Depth----------------------------------------------- Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------W-------------w-w-----Distance from nearest building------____.___.____.__________.._._____.. �dC ❑ Distance to nearest lot line-- --- -- ------ - --- ----- --------- ---- - ----------------------- -- Remode4in and/or b n � g repairing (describe):----------- { 1�---- ---- -b-------------`� t--�� `- ------------------------•------•--------- -------------------------------- -------------------------------------------- --------------------------------------------------------- --------------------------:------------------------•--------------•---•-•--- -----•-•--•• ......---••----------_----- r r .. �" -fl;hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. r (Signed}---------------------------------------------�k&I�NA----------I.A e------------------------- ---------------------•------------- ----I wrier and/or Contractor) BY=-:----_- --------••---=•-------------� -- --- -- ----- -------- --- -------- --------------(Title]------- --- ------------ ------ ------------- (Piot plant`showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION,ACCEPTED BY ---:------ ----------- ----- ------------------- DATE f A`�� ---- -------------------------- REVIEWEDBY----- ----=-------------------------- _- ------------------ ----- ------------------------------------------------------- DATE------------------------ ---------------------------------- BUILDING PERMIT ISSUED------------- ------ ----------------- ,DATE------------------------------------ _----------- Alterations and/or ecomr�lendatians: - -=-- --------- ------- -t — +� --------------- ---/f `z �•`-`►'�_- �` -= I� - . ---------- -- - -- -----• --------------------------------- i ----------------------------- -------- ------- ----=---- -- --------- ------------------- --•------------------------------- ------------------------- ---- ----- ----- FINAL INSPECTION BY:----- - lam`".-`- --------- Date_ //`x 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 F.P.co. '�