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FOR OFFTCE.USE: i -ri------------------------------------ - -------- ---- ---------------------- ----------•-- APPLICATION FOR SANITATION PERMIT Permit No. .�_�.��-�= -------------------------- -- --- ---------------- This Permit Expires 1 Year From----- (Complete in Duplicate)Date Issued Date Issued f..�-.r.s--'� - --------- ------ ---------- _ - ------------_-_-_.- Application is heT'eb'ymade 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. -- ------------------------- JOB ADDRESS AND LOCATION---� .� ------- --------! l�P - -------- -�------ - Owner's Name �1 .. '. - - be - Phone...��'�6.Y1.._Q- -------------------- - --------------------- --- Address � . -------------------------------------------- --------------------------------`------•- -- .¢ 3 Contractor's Name-... 1--- I --�-� --� ------------------------ ---------- ---------- - -- Phone.._. Installation will serve: Residence Apartment Apartment House E] Commercial ❑ Trailer Court [I Motel [I Other [I rooms - -- Number of baths I--- Lot size ._�')CIa�T!��-=-•---=-•------------------------ Number of living units: -------- Number of bedl Water Supply: Public system ❑ Community system ❑ Private [W Depth to Water Table/ - ft. Character of soil to a depth of 3 feet: Sand (f Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes date...- _-_... ---) No -New Construction: Yes ❑ No FHA/VA: Yes ❑ No ~ TYPE�4F�1N5TALLATION AND SPECIFICATIONS: .�..� _.� — T ,— (No septic tank or cesspool permitted if public sewer is available within 200 feet.[ --- Septic Tank: Distance from nearest well__-.�`_- -.Distance from foun .�_-. dation._.. _f?-,----_.Ma3eriai,. No. of compartments Size l O Liquid depth Y Capacity ---A--- Disposal Field: Distance from nearest well----6 -.-Distance from foundation.._-f ..__....Dia#ante to nearest lot line..- ...-._. Number of lines-----------/-_ -- ---- Length of each line--.-.-3Q- -------Width of trench-....__ r. -_-- -•--- Type of filter material._.- -d ".---Depth of filter material- -.- -__..__..Total length.................:. 1. -----------, Seepage Pit: Distance to nearest well---------------------- Number of pits------------------- 9 Distance from foundation....................Distance to nearest lot line-- ---- Linin material---------- ------------Size: Diameter-----------------------Depth ❑ Cesspool: Distance from nearest well from foundation__-----------------lLining Cat material gals. ❑ Size: Diameter_j ----------.Depth------------------------------------------ ----- q p Y IDistance from nearest buildin Privy: Distance from �earest well --------- -------- ----------------------- g------------------------------------------ Privy: ---- --------- ----------- ----- --� ❑ Distance to nearest lot line................... ... -------- ----------------- ---------------------- ------------- --------,�3_RA_ek.1 � _rje ✓_4---------TO-----COP------------------------ Remodeling and/or repairing (descrihe):_.... �"=- --- �i t7 ---------------------- ------------------- i --------------------------------------- f -----------••------------------------•----•-----------------=•------------------------------------------------ ------=--------------------------------------•--------------- 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 nd regulations of the San Joaquin Local Health District. .rte cs -------- caner and/orContractor) (Signed) ---------- - ----- ----- � �- --. ........ ( -------------------------------------------------------------- ------------------- (T t e (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTME SE ONLY APPLICATION ACCEPTED BYt-R, � DATE DATE-----------=------------------------------------------------ REVIEWEDBY--------------------------------------------- ------------------------------------------------------------------------------ -- --------------- -- ----- --- - ---------------- ---- -- - BUILDING PERMIT ISSUED----------------------------- ---------------------------------------------------------------- .--- DATE � Alt � ti � and/or recom enda ions:----a%- �•'----- ------- -------- ------ - -- -- -- ---�---- - -------------------------- FINAL INSPECTION BY:..--- -...�-- - - - - --------- ---------------- --- Dafie. 7 0--(----- --------- --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT f 1601 E.Naxelton Ave. 300 west oak street 124 Sycamore Street 205 West 9th Street Stockton,CaHFornta Lodi,California Manteca,California Tracy,California F.P.CC.