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r FOR OFFICE USE'- __-..-----___------------------ APPLICATION FOR SANITATION PERMIT" Permit No. -- (Complete in Duplicate) 3 f (a Date Issued ---------------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin-Socal Health District for a permit to construct and install the work herein described. This application is made in compliance with Co my Ordinance No. 549. t JOB ADDRESS NDLOCATION �C----749/7n " � � ----------- i Owner's .Name -� L , - -- -------------- ------ --- -----° ------------ ...... Phontl ------- Address------------0- ------ ---------------------------------------------------- Contractor's Nam _ . _ j ---------------------- Phone_----------•------ � ; Installation will serve: Residence ❑ Apartment House ❑ `Commercial ❑ Trailer.Court ❑ Motel ❑ OtheslZiQtEy I Number of living units: j----- Number of bedrooms _Number of baths -------- Lot,size _rxZ.rO �Z-410_,o__________________ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------1 No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well-_p_ .-__Dista je. from fo --------Material--- __ _-- _ No, of compartments-- 7�-G---- -_- -- -_ i uid de th__ ___ Ca acit p I 7 q ------- p y--- Dispo al Field: Distance from nea��jjst well_(Q_Q________.l3istance from foundation__©-/___.-__Distance to nearest lot li e__ ._.___ Number of lines _.P� ___ -- -- _ ___Length of each line/16 - -_.Width of trench...I� _-_� ------------------- Type of filter materia____ _________ __ ____Depth of filter material--_._ -----------Total length-_- --------------------___- Seepage Pit: Distance to nearest well----------- _--_--Distance from foundation--------------------Distance to nearest lot line__-_______-__---_ ❑ Number of pits.J-------------------Li ing material-----------------------Size: Diameter------------------------Depth---.------------------------------ i 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----------------------------------------- . [] Distance to nearest lot line----------------------------- ------------------------------------------------------------- ------------------------------------------------ i RemodeSing and/or repairing describe): T --- ------------------------------------------- -. ------- ------------------------------------------------------------------------- 1 �- ------ - ------------ ------------------------ -----------------------------------=------ ----------------•------------------------------------------------------------------------------------------•------------------•------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------.-...--. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Wt la s, an rules and regulations of the San Joaqui Local Health District. L ( g r 0 ) Si nt: --- r Contractor By:------------------------------------------- ------------------------------------------------ ------ -------- (Title)----------- ------- -----------------------...----------------- (Plot plan, showing size of lot, location of system in relation to Ifs, buildings(etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY / I APPLICATION ACCEPTED BY.......... _____-_!_____________ DATE_ lo`/ REVIEWED BY--------- --------- ------ --------- ----- - - - --- ------------------ -------- ---- - -------------------- ---- DATE----- ----------------------------------------------------- - BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------- --------------------------------------------------- Alterations and/or recommendations___________________ -` ------------- ---------- -- ------------ --------------------------------------- ----------- -------_:---------------------------------------------------------------------- ----------------- --------------------------- --------------------------------- ---------------------•-------------------- ------------------------------------------------------------------------------------------•----------------------------------------------- ------------ ------------- ------ -- --- ------- --- ---- -------------- ----------------------- FINAL INSPECTION BY:----- ---------------- Date........s. ........... ------------------------ SAN JOAQUIN LOCAL HEALTH .DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lad!,California Manteca,California Tracy,California F.F.-Ca.