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FOR OFFICE USE: T ------------- _.------------------------- ---- -------- APPLICATION FOR SANITATION PERMIT Permit No. ------------ ----------------------------- - (Complete in Duplicate) ` y ------------------ - ----------------------------- This Permit Expires 1 strict for a ate Issued_ Date Issued - - Year From D ��,�— b7b—1-7 Application is hereby made to the San Joaquin Local Health Dl permit to construct and install the work herein des ibed. This application is made in compliance with Co u ty Ordinance No. 549. /-3 fit• ( 4„� �T• �rv1-MC�, JOB ADDRESS AND LOCATION_ '�'r - j - - - � j--- _4.4......... Owner's Name_-- �-- -------------------•---------------------------------------------- ---------- --------------- --------- Phone-------------- -----•-----------•--- ;. Address---------------- �Z.r�-�------•---•--------- --------:-- ----------`�'"-��s--.. �' ` --------------- -- •-- -------- - -----�r—� ------------ Contractor's Name--- ----------------------_----- Phon Installation will serve: Residence �rtment House ❑ Commercial ❑ Trailer Court [] Motel Other Number of livingunits: _1-.__-_ Number of bedrooms �❑ ❑� �j-__ Number of baths __.�__ Lot size __�_��-__"--P�.._f�Q------------------ Water Supply: Public system ❑ Community system [❑ Private 2--�Depth to Water Table ------ ft Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam (] Clay Loam ❑ .Clay ❑ Adobe B-lHardpan ❑ Previous Application Made: (If yes,date------------_------I No ❑ New Construction: Yes ❑ No- FHA/VA: Yes ❑ !tNo ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: __/',,_(No.sepfic,fank or-cesspool permitted if.public sgwer is available within 200 feet.) � t t tic Tank: Distance from nearest ell_ Q....Distance from founaL- ---------------------- No, of compartments_ + Size if ' Se t' 6�J. 3-+ ? - - ti uid depth s --..--------Ca acit d --0 Disposal Field: Distance from nearest well.,.Q�---Distance from foundatio�a_-_ .S�t_______�Distance fa nearest lot line---- _ •___ Number of lines--._ Length of each line 0, ------------- -- - g i��_,�O__.Wid+h of trench.- -��- __-- ------ ,3 ?_ Type of filter,material_ - ,Depfh of filter material___- -----Total length---------------------A Seepage Pit; - Distance to nearest well _Distance from foundation-------------------_Distance to nearesf lof line---------------- Number -----"Number of pits--*_--------------------Lining material------ ----------------Size: Diameter-------------- Depth-----------,------ # Cesspool: = Distance from nearest well-----------------Distance from foundation-----------------...Lining material---------"_ : _�----�' ❑ Size: Diameter--------------------------- De Depth::. p -- ------ - - -- --- --- ---_ -----Liquid Capacityg gals. Privy - _- D stanceifrom nearest.wet! T ._____ __ __ _____ ___ _ ____ Distance from nearest building---------- ----------- ____ __-- Distanceto nearest lot line-- ===-=---- R -- ----- - ---------- - ---------------------- --- -------------- -- - �--- ----------- - �� Remodeling and/or repairing (describe): ----- 1 ribe�:-:---- � { r AFLaS' /V-O_iv - - - -.--- -:---------------------- ----- -- --------------••--------------------- ----'----------- ---------- - ----- r .. '-�'y. - ------------ ---1 -�-Z? A -------------------------------•�-_----------- — ------------------------- , ----------- ---------'� 1 hereby certify that I have:.prepared this application and that the work 'II be done in accordance with San Joaquin County- ordinances, 1 S la s, an rules-'-and eguI tions of the San Joaquin Local ealth District. 11 L [Signe ---- - ------- -------------------------------------- or Contractor) BY:------------------ --------------.------------------------------------------------ ) (Plot plan, showing size of lot, location of system in relation fo wells, uildings, etc., an be placed on reverse side). 4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------- ----- ----------------------- ----------------------------- -.- bATE REVIEWED $Y------------------------------------ -------- ------------------------ ----------------------------------- ----------------- DATE - ---� -- -- --- ------ ----------------- --- BUILDING PERMIT ISSUED--------------•-----------------------------------------------—-------------------------------------- DATE----------- 1 Alterations'and/br"recommendations__ _ _ _______ `-- ---------------- ----------------------- - ------------------------------------- t- _ ------- --------- ---------------------------------- --------------- 1 --- FINAL INSPECTION BY.. ------ ------------ ------------- Date - -------- -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California 6