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FOR OFFICE USE: _I -------------------=------------------------------------- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _!/-- ._._ '- (Complete in Duplicate) Date Issued /Z_-_s?A�_-a - -------------------------------------------- --- This Permit Expires t 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. JOS ADDRESS AND LOCATION_ ,__ P _ __ .__ ____ �'---` L -------r-e n ----- Owner's Name_�e--.--- Phone._a--------------------------------- Address---------- +? _.. < �_ �. - i f --- ----- ----------------------- Contractor's Namea `� rP t Phone --------------------•---------- Installation will serve: Residence L'_I Apartment House ❑ Commercial p Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___f__ Number of bedrooms __'/ _ Number f baths -2-`_ Lot size ------ ____________________� Water Supply: Public system E] Community system ElPrivate Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 2111"CSay Loam ❑ 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.) Septic Tank: Distance from nearest well___ _r.__Distance from � .� foundation_-. _14�_'*___Material___-__041 .-________________________ No. of compartments Size 1-I - -X._.�ji uid de th____._.�__ . .---- Capacity -p�.- _ DispoField: Distance from nearest weil-----,W---Distance from foundation-----/0____------Distance to nearest lot line_4-__..._____ Number of lines---------�-----------------------Length of each line--------f4o --.---.---.Width of trench__=2-- -.--------.--.-.------- Type of filter material----- �� _t________Depth of filter material_____-Iy_t_r_____._Total length_____Id,u_________________________ Seepage Pit: Distance to nearest wel)----------------------Distance from foundation ----_.__ __ Distance to nearest lot line_.__________-_ Tir, E] Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Deptn__.---.--..---------------.------ Cesspool: Distance from nearest well-----------------Distance from fou`n .'-fion._______________..Lining material _.----------------------------------- Size: Diameter - --------- ---De Depth -------------- "---------- -------------- ❑ ---------------------- - p � _Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------------------------#� __--....Distance from nearest building--- -- -------------------------------- ❑ Distance to nearest lot line-------- ----- -- - -----------------------------i---------------------------------------------------------------------- t Remodeling I --•- .--- .!-+ ---------------- &-------.-•-�, � �?s� .�__�C _ r I ------------------------------------------------------------- .o ------------------------- - ------------------------------------------- --------- ------------ •--------- ---------- ---------------------------------------------------------------------- --------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Statlaws, and rules and regulations of the San Joaquin Local Health District. ; (Signed)------ --� --------------- ------ ---- -- - - --------------- -. - carer and/or Contractor) ---------------Title ------------ t BY �- < '�-° -----: ( I-- --- - �: (Plot plan, showing size of lot, location o system i relation to wells, buildings, etc., can be placed on reverse side). k ♦ w s .� L , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------------------------------------------------- DATE--/� 4 1 -- ------------------------ REVIEWEDBY----- ------------------------- --------- - --------- --------------------------------------- ------------------------------ DATE------------------------------------------------------- ---- BUILDINGPERMIT ISSUED------------- ----------- ----- --------------------------------------------------------------------- DATE------------------------------- -------- Alterations and/or recommendations--------------------------- ------------------------------------------------------------------------------------------------------------------------------- --- --------------------------------------------------------------------- --------------------------------------------------------------------------------------•-- ---------- --------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------- --------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:- _�-- -------------------------------- Date_----��J- 1 -----C_.--------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hoselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.