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FOR OFFICE USE: ------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. - -------------------------------------------------------- ------------------------------- -- -------------- (Complete in Duplicate) Date Issued __ ___ _ _ This Permit Expires 1 Year from 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 compliance with County Ordinance No. 549. 3 4 „)_U ��r/ f ' i- JOB ADDRESS AND LOCATION-----�y----- y 'mak 7 --- _��a/,?��I -- ----- Z---1' Owner's Name---------- ---/Q tr.-� � ^'P-�_.------------- Y Phone Address__.--------_--------------- 1 a�.r ,4l----- rF-l.--v tlU r` ' /'✓Cyr --------------- Phone- � - . Contractor's Names '-r-,_ .,r -- ----------- - -- - - 1 Installation will serve: Residence [g�Apartment House ❑ Commercials❑ Ti;iier'Court ❑ Motel ❑ Other ❑ Number of living units. Number of bedrooms _- _- Number of baths --/--- Lot size -___-l_51e -'_, ----------------- Water Supply; Publics stem Communit system ❑ Private Depth to Water Table 1�ft,�t pp Y� Y ❑ Y Y � p Character of soil to a depth of 3 fee+:. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay D--Adobe ❑ Hardpan ❑---' Previous Application Made: {If yes,date---------_,--------1 No [ New Construction: Yes ❑ No ©- -FHA/VA: Yes ❑ No t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material---------------.--__._._-_----------------.-... ❑ No. of compartments--------------------------Size--------_-----------------------Liquid depth-------------------------.Capacity..--------------------- Disposal Field: Distance from nearest well --__._-Distance from foundation -_-Distance to nearest lot line--JD---_--- Ua ❑i,11, Number of lines-------- ------------Length of each line---XzZ!5! --------Width of trench...... -L'=.--------------------- t� Type of filter material--- f.Ar'.Depth of filter material_-,f.-. `_---------Total length----ZzO�Q-_-`-------__-__------.- Seepage Pit: Distance to nearest well-`,1;9�1----------Distance fro foundation_-__ ---Distance to nearest lot line-_Z4?........ p 0'- Number of pits-------- =----------Lining material__ il�.-Size: Diameter---5_- _-----Dep -- ----------.-.--- Cesspool: Distance from n�rest well-----------------Distance from foundation--------------------Lining material-- -----.-..---._____---.--.------ ❑ Size: Diameter-- --------- Depth---------------------------------- -----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----_------------------------------------------Distance from nearesf building.--.-.__-____-.--------_---------------- ❑ Distance to nearest lot'kne--------------- --------------------------------•-------------•-------- ---------------------- ---------- --------------------- ------ ----- t f � '_----------- k Remodeiing and/or rep airing (describe ,-- ( ----------� �------ -'� r -------------------------------------------------------------------------------------- -•-------------- E --------- ----- - ----p----- .----�p-------- ----------------------------------------------------------------------------------------- n o the San Joaquin H ill'Ue done in accordance with San Joaquin County I herebycertifythat I have re Bred this a lira+io� ` ordinances, State laws,land rules and regulations f l q Health District`. i »wet k ((Signed) :!� -.��= :f: s/7: - �"' ------------------------- �wner "d/or Contractor g BY• _ 1 -�_ �;-- s-: f ---- -- --- ------ - ---- - - ��i?�Z �= .. - .Id [Title) ��l . (Plot plan, showing size of lot, location of systern in relatl�wells, buildings, etc., can be placed on reverse side). II FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. 1 ------- DATE- -d__� � -___-. ----------- REVIEWEDBY--------------)------------------ ----------- ----------------- ---------------------- •------- DATE------- ------------------------------- --- BUILDINGPERMIT ISSUED-------------------------------------------------------------•--------------------- )-------------- DATE------------------ ------------------------------------------ Alterations and/or recomm�ndafions------------------------- � ----------------------------- ---------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------ - -- ------------- - -------------- - ----------- - - ------ ---------- FINAL INSPECTION BY:...-- - Date...�l_-- �S SAN JOAQUIN LOCAL HEALTH DISTRICT r 1601 E.Huxellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.