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FOR OFFICE USE: f - ` ----------- x- APPLICATION FOR SANITATION PERMIT Permit No. _v . ------------------------------------------------------- (Complete in Duplicate) Date Issued --- -------------- -- ------------ This Permit Expires 1 Year From Date Issued Application is hereby made to the'San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. I,— '� x x c --------------------------------------------------- JOB ADDRESS AND LOCATION-- __ . _______. ''-,r---�"c�•• -- �` '. �-{J--� �� µ- r--�--- - ------ Phone----- Owner's == ° '=' ----------- r Name--------------- --�-e�Xe ------ -- .��-�---- - ..r Address =---------------------- '-------•--•---•---------------------------------------------------------•------•--- �•--- �. --Zt' c ,/�/-fc�� _ 9. ' Phone. — - �• Contractors Name------- b ! �i -- ------------------------------------------- �f�� Installation will serve: ResiderApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ / Number of living units: _dl -'-Corhmunity Number of bedrooms __ umber of baths _ ___ Lot size..G-lr1___A-----/Water Supply: Public system system ❑ Private ❑ Depth to Water TableC3�_ 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__.a=.... No, New Construction: Yes El No ❑ FHA/VA: ❑ Na E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewerAs-available within 204 feet.) / f Septic Tank: Distance from nearest well_��__.____Distanc from fFundation_ 6---------- - ----------------- No. of compartments------ ------- = Size _-Liquid depth--------#__-.----- . Capacity-•- �------ y f Disposal Field: Distance from nearest well--_ 6_.__---Distance from foundation.-fQ__.._______.Distance to nearest lot lin` __j`=4___. Number of lines_______________ __ Length of each line_-_.__ _ "_-. Width of trench____ 11 ; /. Type of filter material-------- of filter material- � __. ... length-------- ____ ----------------- \ rom foundation________.________- Distance to nearest lot lino----------------- Seepage Pit: Distance to nearest well----------------------Distance f ❑ Number of`pits----------------------Lining material--------------.--------Size: Diameter----------.-------.....Depth--------------------------------- Cesspool: Distance from nearest well-------------- Distant from foundation____________________Lining material_.._----_---___._._.___________--.._.. 0 Size: Diameter------------------ -------------------Depth-------------------------- ----- ------Liquid Capacity--------------------- gals. i Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------------------------. ❑ Distance to nearest lot line----- --------------- -- ------------------------------------------------------------------------- ------------- -------------- W Remodeling and/or repairing {descr.ibe): ------------------ -----------------------------------------------------•---------------------- ` W� -------------- --------------------------------------- -------------------- ---------------------------------------------------------------------------------------------- I hereby certify that I have prepare this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an reg at of the San Joaquin Local Health District, / 4 ----------------------------------------------(Owner and/or Contractor) (Signe` _ - ----- -- ---- --------- - -- -- -------------- rTitle - - -- ------- ------------------------- -- ----------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- - - - - - ----------- --- ------------------- -- --------------------------------------- DATE_ ------------------------------ - - REVIEWEDBY---------------------- "'',- ---------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED________________ :r:_f r -------------- --------------------------------------- --------------------- Alterations and/or re ommendat�ib. y -- ------------------------ --- -------- ----- C = i --------------� �Z �{ � �� t - y -- y� �f------ AL---------------------------- --------------- r -- c 'k ----------- 1-;(-- --------- afar' 77 / �: xc fi ---------------- - ---------------------- W- -------- If------ des [A c�cyt,ss /t/uff yDate. FINAL INSPECTIO��BY._ --- l -- --------- -------- ------ ------------ d SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California