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FOR OFFICE USE: �"� -------------------__--- APPLICATION FOR 'SANITATION PERMIT Permit No. Q --- ----------------------------------------------------- -- _ [Complete in Duplicate) _ -_ This permit Expires-1 Year From Date Issued Date issued . _-f - � Application is.hereby made 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. .E JOB ADDRESS AND LOCATION__&-/1,''�_9!'-----.--' rc-------I '---N/---z�-� y cr �L�------- /l Owner's Name ! 1 'J ' - ------------?...�r4?_e Phone AddressJP� .. �f��--`----------��1: --------- ----- �� ---------------•-----------------------•-••------------ Contractor's Name ------ • ---------------------------------------------- ---- Phone--------------------------------•-- r i Installation will serve: Residence ❑ Apartment House ❑ Commercial frailer Cour ❑ Motel ❑ Witheri r ell Number of living units: ________ Number of bedrooms -------- Number of baths _______ Lot size ____________ ___ �- + Water Supply: Public system ❑ Community system ❑ Private 'o Depth to Water Table ------ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: {if yes,date____________________] No M� New Construction: Yes o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: s tank or cesspool permitted if public sewer is available within 200 feet.] t is Tank Distance from nearest well____-___Dist ance'from foundation__._ 1 --"----.Material--Ca'_ - --�•�---"------- No. of compartments.. Size , ?fry---------------Liquid dep�-------1E-------------Capacity--"9--- ------ Disposal Field: Distance from nearest well__- --- Distance from founds�/ion- _,, _-.Distance to nearest lot line f)` � Number of lines-_..I----------- ________. Length of each line___/_ -------____---_----W,clth of trench____'. �-.______________-._ Type of filter material-_ __,___ ,<' Depth of filter material__,�_ Total length__-_ ____________________________ Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line__________..___ [] Number of pi+s----------------------Lining material-------------------_--Size: Diameter-----------------------Depth-.----.------------------------.. Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material--- ❑ Size: Diameter- -------------------------------Depth--------------------------------------------------Liquid Capacity -- __ -_..gals. - - .� �_--.,. y ter.:'- ,.` -- Ya T.� - t �.�- •- �nvs�+��=. Privy: Distance from nearest well__._____________________:____ ____ Distance.from nearest building... _______ ___ ❑ Distance to nearest lot line-------------------- ------------------------------------------•-------------------------------------------------------- _ Remodeling and/or rep 'ring (des( 7 -.. __Pt�L 2�Fwiill�6e --1-- . --�• X --r !------------------------ f� ---- ----t'`� = ' t 1��1�_-L -tt - � rs ��i '` ----1 rc.t --- -------------- ------------ ------------------- •------- •-------------- --------------------------------------- ------------------------------------•--------------------------------------- - I hereby certify that`I have prepared this application and +hat the wordone in accordance with San Joaquin County ordinances, State laws, and rules and re II tions of the San Joaquin Local.Health District. (Signed) .. r -C�----- �✓u-t1 ----------- g ) (Owner and/or Contractor By: . -------------------------------------r-----------------------------------------------------(rifle)---------- -------------- .....................--------------- i (Plot plan, showing size of lot, location of system in.relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------------- ---------------------------------------------------------------- DATE------ --------------------------------------------------- REVIEWED BY------- - __--' BUILDING PERMIT ISSUED -= -------------- - DATE Alterations and/or recommendations:_------------ ------------------------_-----------------------------------• ---•-------- •-------- ---------------- i �. - -----------------------------------••---------------------- --------------- -------- ------ = ---------- ----------------------- --------------------------•------•------------------------------------ a -------------------------------- -----------------------•-- =--------"-----:----------------------------------------- -----------..------------------------------------------------------------ -------- FINAL INSPECTION BY:- --- Date- - ........---------------------" -•------- t SAN JOAQUIN LOCAL HEALTH DISTRICT ' 1601 E.Harellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California !` f