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sir F1ROFFICE USE: 3 .. /° .,,r 3.?,7—/_� ----------------,rte'= - APPLICATION FOR SANITATION PERMIT Permit No. _.� _ _. --- ------------------------------------ ---g1s,,C)--- [Complete in Duplicate] --- This Permit.-Expires 1 Year From Date Issued Date Issued Application is hereby made to the'San Joaquin•L-ocal,Health District fora permit to construct and install.thework herein described. This application is made in compliance with County Ordinance No. 549. �� S JOB ADDRESS AND CATION..0 w. -- ._.. f --------------------------------------------------- Owner's Name------- ��- Phone •---- Address '�i�� .sir.-- /��.................•---------------------------•--------------.----------------------------•----------------•--- Contractor's Name 4leAV/A- ----------------- Phone Installation will serve: Residence [Apartment House ❑ Commercial '❑ Trailer Court ❑ Motel ❑ Other ❑ !4 Number of living units: __4 Number of bedrooms _ _ Number of baths Y--- Lot size __./- ��± - - -----•----------------------- Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Tablets• ` Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑' Adobe &-.�ardpan ❑ Previous Application Made: {If yes,date -----------------..I No Z?ANew Construction. Yes &^o ❑ FHA/VA: Yes 99---No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p Septic 'Tank: Distance from nearest well------ .---Distance from m found tion____/P_`_.__--Material__d,lr._!�.'�----- ____._____. 99/ No. of compartments___.________-____5izey�? _rX_ �_____-.Liquid depth_'��_____________Capacity__Pi��___._. 01 Disposal Field: Distance from nearest well.._.. Distance from foundafionrZe____..__.Distance to nearest loot line_-a�7__-..... Number of lines_____--�`_ __ -' ..._ ____.__ Length of each line74_ -_____ Width of trench_.r ___,_______________-__-_ Z Type of filter material- / d+ Depth of filter material__. __._______Total length__ ____._ ------------------ Seepage Pit: Distance to nearest rwsiL- _-'—_'__.---__Distance fr m foundation-____erV_____.___ Dis�tance to nearest 1 t line_4 _____._. Number;ofypits_____.. __.__ __..L-Lining materiai,��✓10. Size: Diameter._�s.:r__r-___-.Deptn_� `!_f4i_i, Cesspool: Distance from nearest well-----------------Distance from foundation--- --------------Lining material-------------------------------------- 0 ❑ Size: Diameter- --------------------------Depth----- ------- -------------------------------------Liquid Capacity------------------------ gals. Privy: Distance from nearest weEl-----_ .--____.._____.______.__-_Distance from nearest building-----___-------------------------._.__... ❑ Distance to nearest lot line------------------- --- ---- - -----------------•------------------- ---- ----------------------------------------------- - Remodeling and/or repairing (describe):--------- --•--- -------------------------------- ----------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------- ro ------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------- - --------- 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. '� -_ ------ or Contractor (Signed)----------- ) (71t1e] ---------------------------- ---- IBY= (Plat plan, showing size of lot, location of system i relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ----- -- �c� '�L------------------------------------- DATE----- REVIEWED BY l DATE__.-. -------------------- ----------------- BUILDINGPERMIT ISSUED----------------------------------- ---- ----------------------------------- ----------- DATE-------------------------- ------------ - ------------------- Alterations and/or recommendations:____) _ -_____. .-c___,-.___/ �1. _.__ -` `� �-"_-- - - �� ---�_ � . '7�_e ------- --------- --- -= ,r - •r�--c mit` ° A� `x y�� t ] l--L- e ------------------ --------------- 2 Y a , � ci -- ---- -- � a� FINAL INSPECTION BY:---------R•_?e-------------------------------- ------- Date-------- X --------+f-- -- - ---- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 4, 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy, California