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FOR OFFICE USE: ------------------------------ -------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _ ..._.-_•............. ---------------------------- - ----------- ------------ (Complete'in-Duplicate) Date Issued .�14-p-Aw�—, ._..................... ................. . ........... This Permit Expires 1 Year From Date Issued 0',2t? Application is hereby made to the San Joaquin Local Health District for a permi#.,to cons ruct and install the work herein descrledo_ This application is made in compliance with County Ordinance No. 549. a S"p LV - JOB ADDRESS AND LOCATION �'"j .... / ---/a----------,�---- j� Owner's Name------------- �! Phone------------------------------------ Address____--__ �� 'z' Contractor's Name ----------------- Phone-_�./ ---------- -------------------- Installation will serve: Residence//[B�Apartment House El Commercial El Trailer Court El Motel El Other 11l-- Number of living units: -_ _ Number of bedrooms _3- Number of baths .__ Lot size ...... ------------------------ Water Supply: Public system ❑ Community system ❑ Private 2T-`*Depth to Water Table , _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam lay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date......... ..........I No R-' New Construction: Yes No ❑ FHA/VA: Yes ❑ No ❑ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: pp (No septic tank or cesspool permitted if public sewer wer is�railable wi+hin 200 fee Septic T Distance from nearest welL�_._--------Distant from�f°und ion---/_________.Ma eV. _ 2______________________ No. of compartments---_3_____ _..r_ Size Liquid depth------ ._...Capacity_�� _ ------------ - Disposal d: Distance from nearest well-SP- -- Distance from foundation--/P-_.....-.Distance to nearest lot line.__.-_-__-_-. of lines_--Jam______________ Length of each line_�d fr-------------- Number .._.Width of trench.___.._Q7_`51-F--.-----_-_--- Type of filter of filter material----/g__----------Total length____________________n_7'_Q___...__ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- F1 Number of pits--- -------------- ---Lining material--_--. -------------.-Size: Diameter-------------- --------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------_-------------Lining material-------- A ❑ Size: Diameter- -- --------------- ----------------Depth---------------- ------------------ - -------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------.-...... ._Distance from nearest building.----- _--.-_----_--.-_--.-._---._._____- ❑ Distance to nearest lot line - --- ----------------------------------- ------------------------- ----------------------------------------------._....------------ �y Remodeling and/or repairing (describe)-------------- ------------------------------_- -----------------------------------------------------:-------_•---------------------------------------v ---------------------------•---------------------------- ------------- ----------;------------------------•------------ -------------------------------1 ----------------------- ----------------------------------------------------------------------------------------------------------•----------------------------------------------------------- ---------------------------------------------------- • ----------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -E'1 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat ws, a d rules an regul ions of the San aquin Local Health District. . c (Signed) ---- -- ---- -1�,�6 ----A------- ------------- ....... ( wrier and/or Contractor) C B - ---------------------------- I - ---- --------------- ---- - Y = - - {Tit e)-- (Plot plan, showing size of lot, location of system in relation touildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----___..__.__.. DATE______-_-_. REVIEWED BY-------------------------------- - - �-�--L----------------- - ---------------- -- a ---------------- - -- -- -----_._ _ - - ---------------------- ---- ---------- ------------------ DATE----- ---- -- - -- --- ----------------------------- BUILDINGPERMIT ISSUED---------------- ---- - -------------------------------------------------------------------------- DATE--- --------------------------------------------------------- Alterationsand/or recommendations:.------------------------------------------ - --------------------------------------------------------------•------------------------------------------------ ---------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------ ----------------- -------------------------------------------------_1------ --------------------------•----------------------------------------------- --------------------- ------ .......... ---------------- -------------------------------- ---------- ------------------------ --------------------------------------------------------------------- elolo, j `�_ `�FINAL INSPECTION ------------------ - Date- -- - --------------------------------------------------------- SAN --------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Ma:eiton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California+-• Manteca,California Tracy,California 4 F.P.CO.