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FOR OFFICE USE: --------------------------------------------------------- �17- _______________________________________________ APPLICATION FOR SANITATION PERMIT Permit No. . . > -Q ---- -------- --------- ----- ---.-- (Complete in Duplicate) 1 Date Issued __ ____ _d__ 6 _______� -.- ---...- This Permit Expires 1 Year From Date Issued p —040-0 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein Oscribed. This application is made in compliance.,with County Ordinance No. 549. JOB ADDRESS.AND LOCATION_`;!'_'-:-.--. r= ----- `----'---------- -R ".n_ -------- ,r---------------------------------------- Owner's �- ' t,�:�,t _ �" Owner's Name-------- :^rt�G -. .?e '= '="--------•-------- ----------- Phone---------------------------- Address--- ----•-------- ----------Address----•-----------•-•----------............----- / rv<-_y ---- -41"/ . ----•`-----------------•----•-------------------------------•--•--•----------------------- ...._.. ,a Contractors Name-_ - �^'•-^-;rte, ------------------------------------------ Phone.---------•-----._- .....---------- Installation will serve: Residence '� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ f Number of living units: -)------ Number of bedrooms--__-_ Number of baths -- -____ Lot size ----J-�Z--- '------------------------------ Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table ,"--n.- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ZI Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date- - ----__----) No 'KJ New Construction: Yes d 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-----------------Distance from foundation------.---------___Material-----_----------_______--.-.------.----._------. ❑ No. of compartments--------------------------Size------------------------•-------Liquid depth.-----------------------.-Capacity---------------------- Disposal Field: Distance from nearest well--4._d.--.--_-Distance from foundation--fib..-----------Distance to nearest lot linwE--------------- El Number of lines-------/___ A _-__Length of each line---)7s-------- -------Width of trench-?;4- - -- --------------------- Type of filter materiarr:- _ t!!• Depth of filter material--1. ---------------Total length--j-q-4- Seepage Pit: Distance to nearest well----- ----------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits------------------ ---Lining material----- -.- ---.-------.Size: Diameter-------.----.-.--------Depth--------------------------------- Cesspool: Distance from nearest well----------- --Distance from foundation-_----------------Lining material------------------------------------- 0 Size: Diameter- --- -------------- ----------------Depth-------------- ------------------------------------Liquid Capacity----------------------------gals. ' Privy: Distance from nearest well---------------------------------------------_--Distance from nearest building-----------------------------------------. ❑ Distance to nearest lot line--------------------------------------- ---------------------------------------------------------------------------------------------- Remodeling and/or repairing (clescribe): --'---------•----------------------------------- ------------------ ------ --------------------------------------------I------------------------------------------------------------------------------------------------------------------------- ------------ 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. _ r (Signed)--------- - ----------- ------------- --- ------ --------- -- - - ------- ---------------------------------------------------- ---------(Owner and/or Contractor) _._ By:---=-•--------------•----•------------.___-.---------------- (Title)-- ----------- - -- -- __ - _ - - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). W FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ----------------------------------------------------------------- DATE---- -y/ --- - REVIEWEDBY------------------------------- ----------- -------------------------------------------------------------------------------- DATE---------------------------------------- BUILDING PERMIT ISSUED--------------------------- ------------------------------------------------------------- DATE-------------------------- ---------------------------------- Alterations and/or recommendations:----- --------------- -- -- -- - ------------------------------------------------------------------------- -------------•------------- ------- -------------------------------------------------------- ----------- -- -------- ------ ---------- ----------------------------------------------------------------------------- ------------------------------- FINAL INSPECTION BY:-��u:- ,._ ---------------------------- - Date...."`.- .`� SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.a o.