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FOR OFFICE USE: -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . �1.. --5. ------ (Complete in Duplicate) _---- This Permit Expires 1 Year From Date Issued Date Issued ___ � ___ Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal[the work herein described. This application is made in compliant with County Ordin ce No. 549. 2S3 -too-0,6 3 0 L_✓p 0 JOB ADDRESS AND kOCATIO __ �F' =v l�X, �T z F------ �J '' .� •r__ Owner's Na e-- C .. 'f ?�- ------ -C��--�----- - Phone rJ --------------------- --- -- Address �-------------- -.....- f---9--1-- ------------------' ... Contractor's Name------------------- ----- ------------------------------------------------------------------------------------- - - ------------ Phone------•---------------- X. Installation will serve: Residence ❑ r�tment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other L � Number of living units: -- -__ Number of bedrooms -------- Number of baths -------- Lot size ____. _ t__.___ _ __________________ Water Supply: Public system ❑ Community systemPrivate�J Depth to Water Table/vz&. Q Character of soil to a depth of 3 feet: Sand E] Gravel Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: llf yes,date--------------------) No New Construction: Yes No ❑ FHA/VA; Yes ❑ N0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi .Tank: Distance from nearest well_,/_7,2 �__Distance fro fo nd tion-----I�---- -.Mat I----.-.-- C�/I�! a No. of compartments--------;,1----.��----Size ------- -�___`X_6_Liquid depth------ a----_---------Capacity-- - % Disposal Field: Distance from nearest well__Jf1� CDistance from foundation_//_--- - ----- Distance to nearest lot linelr__=___�: Number of lines-__-____{--_______ Length of each line_-..___(C1 -- -----Width of trench______ __ ____ _______________ Type of filter material,�7_�V.e-, -_Depth of filter material -_--/.9----------Total length-------- _61--__-__._______--- Seepage Pit: Distance to nearest well----------------------Distance from foundation_____________ _ --_---Distance to nearest lot line-______.______ - [] Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth_ ---.______.___---__-.-------. (� Cesspool; Distance from nearest well________________ Distance from foundation--------------------Lining material--------------.._._._._.___-_----..- ❑ Size: DiameterDepth------------------------------------------- --------Liquid Capacity- - ------------------------gals ...f ,..._ ., _ _ �•. Privy: Distance from nearest we Distance from nearest ui! in ____ _ ❑ Distance to nearest lot line-- -------------------- -------- -_ - ---_ N_ Remodeling and/or repairing (describe):-----c ---- -----------' ---14------ am ------------------------- ---------------------------------------------------------------------------•- ------------ -------------------------------------- ------------------- ----- ---------------------------- --------------------------------------------------------------------------------------------------------------•---------------------------------•---•------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- - - - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law4, and rules and regulations of the San Joaquin Local Health District. (Signed)-- �' `� --------------------------------------------- ----------------------------------------------------------------------------------(Owner and/or Contractor) By:-------------------- -------- . •-•.....__ (Title)----------r- (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---------,-------•r REVIEWED BY---------------- --------------------------- ------------------------------------ ----- ------- --_ r DATE--------` �� T_ _ 1 BUILDING PERMIT ISSUED-------------------------------------------------------------------------------�� -------- DATE.------------------------------------------------------------ Alterations and/or recommendations:------ ---- ----- ---------- ---- - ----------------- ----------------------------------------------------------------•--------------------------- -------------------------------------------------------•-•-------------------------•-----------------------------------------•------------------------------------------------------------------- ---------------- --------- -------------------------------------------- --- -. -- ---------------------------------------------------------------------- - ---------- -------------------------.-.------------ ---------------------------------------- ---- -------- _ t FINAL INSPECTION BY. /%/!:. ------ Date---- ! '-Q--"'c--� SA JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California e _ .- Manteca,California Tracy,California