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FOR OFFICE USE: ----------------------------- --------------------------- ------------------------ ------- --------------------------________________________________ -____----- APPLICATION FOR SANITATION PERMIT Permit No. . `-13 --------------------------------------------------------- (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 w r herein des.7ibed. This application is rnade.igcompliance with ounty Ordinance No. 549. y JOB ADDRESS AND LOCATION---1T_-_f.------- �--�A_�---5�'ral ,��>�--1---2 Owner's Name----- -- 4,HQs/ ------------------------------------------------------------- ------- Phone----------------------------- Address------=----- --l..3--.-� Z�� Contractor's r Name f�- �r�= �� ------------------- -------------- Phone------------------------- Installation will serve: Residence PApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-_ Number of bedrooms---- Number of baths - __ Lot size -___._ ----------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table/27, ft, t x Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Zq/Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date....................I No Z��New Construction: Yes ❑ No e- FHA/VA: Yes ❑ Nom TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)'!' Septic Tank: Distance from nearest weli__,�747__-_.--Distance from foundation___l®__ Materriial_ L!� �No. of compartments___--- -.Size __ ---Liquid depth._.- -------------Capacity.Z� 4V-___ Disposal Field: Distance from nearest well-----------------Distance from foundation__..................Distance to nearest lot line_______.___.____ ❑ Number of lines-----------------------------------Length of each line---------------.-------------.Width of trench.------------------------------------ Type of filter material-------------------------Depth of filter material_____________________Total length---.---_.----------------- ___________.___- Seepage Pit: Distance to nearest well----------------------Distance from foundation------------____--..Distance to nearest lot line--------------__,_ ❑ Number of pits----------------------Lining material----------.__----------Size: Diameter------------------------Depth------__!w --------------- Cesspool: .'_------c_------------ Cesspool: Distance from nearest well----------- from foundation____-------- ------.Lining material -.---______------------------------- El ______________________❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity--- ----------------- gals. Privy: Distance from nearest well---------------------------------- -,._.-.Distance from nearest building----------.-_..--._.-----_-________-__ ❑ Distance to nearest lot Gne------------------------------------------------------------------------------------------------------------------- --------- --------- , Remodeling and/or repairing (describe):____ ' -Pr._ 1 - ��_______-5e,",z ------------------------------------W-----------W-----------W----------------------------------------------------------------------------------------- ------------------------------------ --------------------------------------------------------------------- ----------------------------- - ---------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------=--------- 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 -r'les and-regulatio of the,San Joaquin Local Health District. (Signed)------------------- -�'-/f/6�� ---------------- ---- - --- - ------ --------- ( - -Co (Signed) '! By:----------------------------•--------- ---------- ------------(Title)- (Plot plan, showing size of lot, location of em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY . APPLICATION ACCEPTED BY-- ------------ ------- --------------------- -- ---------------------------------------- DATE-------------------------------------- REVIEWED BY------------------ -------------------------- ------- DATE------- BUILDING PERMIT ISSUED------------------------ -------------------------------------------------------------------------- DATE-------------------------------------------- ------------- µ. Alterations and/or recommendations-----------------------------------------------------------------------------------------------------------•---------------------------- ----------------------- ----------------------- -------------------- ----------------------------------------------- ---------- -----------------------------------------------------------------------------------------------------•--------_----- -----•------------------------------------------------•--------- ------- --- ------ -- -i --- -------------------------------------------------------------------------------------------- -- -------------- ------------------------ ----------- ------ ---------- ------------------------------ 1 � FINAL INSPECTION BY: 4 --------- ---------- - bate l-... .---- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Sheet Stockton,California Lodi,California Manteca,California Tracy, California