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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ------ ----- -------------------------------------- (Complete in Duplicate) �_ / . -------------- From Date Issued 06 Date issues! ---- �-- S - ------------------------------- - ______._._ This Permit Expires 1 Year Application is hereby made to the San Joaquin Local Health District f rte. ermit to construct and insfall the work herein described. This application is made in compliance with County Ordinance No. 49. JOB ADDRESS AND LOCATION 'Q <Jf. ----o -' c ---_2;F/she----- r / / � Owner's Name-----------J__&w1 ----------"rte '1 DP-�-Ae'0 t------ - -- -------- ---- ------------------------------------- Phone-A/Sf - XZ------ Address ,P' r sS��C ar �� ------------- Contractor's Name--------------------- .rG��f.S - - Phone - ------------- � - �. 7 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1--- Number of bedrooms __y_ Number of baths __/--- Lot size -.____________________ Water Supply: Public.system ❑ Community system ❑ Private E+" epth to Water Table ft. Character of soil to a depth of 3 feet: Sand [❑ Gravel ❑ Sandy Loam ❑ Clay Loam [J Clay [] Adobe ❑ Hardpan ❑ Previous,Application Made: (If yes,date--------------------) No [3"New Construction: Yes ❑ No [3- FHA/VA: Yes ❑ No [}-- TYPE OF_INSTALLATION AND.5PECIFICATIO_NS:.j-.-:_ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material ---__._______-____-._.--__-----..---.-.------. Q ❑ No. of compartments--------------------------Size--------------------------------Liquid-depth----------------- - ---- -Capacity----------------------- i Disposal Field: Distance from nearest well ,/zW�..Distance from foundation_ -----.Distance to nearest lot line--�---_---- dumber of lines-------------/ _- -------------Length of each line----� --------------------Width of trench---.- '--------------- Type of filter material---- � _-Depth of filter material--- .__---.---Total length_--_-ZS---------------------------- 3 Seepage Pit: Distance to nearest well....lam_'..---Distance fr fndation_.'�..5- ._......Distance to nearest lot line---.�+.. . { " Number of pits-------/------------Lining materia# T0u ou---Size: Diameter--ft,----- 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- - - -- --- ----------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):____---- - --------le- ---------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------=---------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances,nd rules and regulations of the San Joaquin Local Health District. (Signed) - ��--------------------------------------------------------------------{Owner and/or Contractor) By :. ..... ------------ rte` - '- __"° :_ Title)_-:=__ •S'7-" _ _�« (Plot plan, showing size of lot, locati n of system in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ON Y _ APPLICATION ACCEPTED BY- - --------------------- ----- ------ --- - �- -------- DATE-------- f-- (a r� - -- i REVIEWED BY----- -------------------------- - ----- ---- --------------------- --- ----------------------- DATE--- ------------------------------------------------------ - ------------------------ -- BUILDING PERMIT ISSUED------------- --------------- -------------------------------=-------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations------------- -------------------------------------------------------------------------------------------------------•------------------------------- ------- ----------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------- --------------------------------- ------------------------------------------------ --------------------------------------------------------------- --------------------------------------------------------------------------- ------- -- ------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ : J FINAL INSPECTION BY:...1 7?7 �- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. - 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California