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J FOR OFFICE USE: _ — ------------------------------------------ --- ---- - APPLICATION FOR SANITATION PERMIT Permit No. ...1...1......... (Complete in Duplicate) ' ------ This Permit Expires i Year From Date Issued 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 complianceTw'th-County Ordinance No. 549. 0 ` -74 JOB ADDRESS AN LOCATION.t�______________ - -- ----- --------------- +� y / Owner's Name----pi--"--- i�------- -•-------- --. .. ► Phone ------------------------------------ Address------------- r t 1 .Ca --------------- -_---------------- - •------ ------------- f Contractor's Name",,,,*7 -------------------•---------------------- -------- ----------------------------------------------------- Phone------------------------- , Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trainer Court-o Motel ❑ Other ❑ 1� Number of living units: __j----- Number of bedrooms j---- Number of baths ---(---- Lot size ` '"r - -------= ^"� . t Water Supply: Public system ❑ Community system ❑ Private. F Depth to Water Table _ ,<7`ft. Character of soil to a depth of 31,feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Ciay Loam p Clay ❑ Adobe ] Hardpan ❑.; `:'' Previous Application Made: (If yes,date_------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �e Septic Tank: Distance from nearest well o.4--Dist c f onn foundation----- - ...._.Material".Z _ 1__11 ----------I (� No. of compartments;�------ ----Size------- ---F.....ate-- -Liquid depth Capacity `Disposal Field: Distance from nearest well_±�4...i__-__Distance from foundation_-.4P.._..._._.Distance to nearest lot line- -.-l Number of lines___._____.._._..____- __Length of each line____ - !__________.Width of trench._" -______..____._--Type of filter material- _ % p i.__De th of filter matervaI---- - --------------Total length--- � ?--!---------------- 9 Size: Diameter------ N.- Cesspool: ---- � . See age Pit: D1istabnce of n+arestw II_'_ ;-." Distance from foundation___---_.- --"__.Distance to nearest lot iine___J._.____--.-- p t g aterial, .�`'`Si w v p Cess ool: DistDistance from r m nearest well"_----------------- ._____-=-1Distance from foundation------------------. Lining material___..--.._-_----------"-"-----__.__.. ❑ f .,,,,,.v �i"Dep �------------------------------------------ ------------------ --- --------------_� Liquid Capacity- --------------------------gals. Privy: Distance from nearest well-------__------------------------_"' ----------Dis'eance•from nearesf building_.__.----------___._____-________.__... ❑ Distance to nearest lot line----------------- - ---------- ------ -�- t-p- ----------------------------------------------- -- - Remodeling and/or repairing (describe):----------------------- -----YE —'� -----------"------------------------------------------------------------------------------------------------------------------------------------------------------------- --------r----------------------------------------- ----------------------------------------------------------------------------------------------------------•------------------------------------------------•------- --------------------------- --------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------- - 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 regulations of the San Joaquin Local Health District. ��, .[- t_ ."-"- µ_ ± _- .-___r�_ __(Owner and/or Contractor) (Signed) -- _,... :_ _ :- ----- - -- -- - ------------------------------------------------(Title) - ------------------------ ----- ------- ------------- - ---- - (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---,�._�'' -z s 7 - ----------"--- ----------------- DATE REVIEWEDBY----- ----------------------------- - --------------- ---------- ------------------------------- ------------------------- DATE-----------------------•------- ----•--------------------._. V BUILDINGPERMIT ISSUED-------------------------------------------------------------—-------------------------------------- DATE------ ------------------------------------------------------ �! Alterationsand/or recommendations----------------------- ------------------------------------------------------------------------•--------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ --------------- -------- ------------------------------------------------------ - ----------------"------------------------------------------------------------------------------------------------------ ---- FINAL INSPECTION BY:. ._ .. --- --------------- Date--/1 �{� ------------------------------------ SAN JOAQUUIN 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.C❑.