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RFFICE USE: -r } -------- --- ---------- ___.___-------------------------------------------_--. APPLICATION FOR SANITATION PERMIT Permit No. ---------------- - ------------------- ----------------- Date Issued _ - a (Complete in Duplicate) 6 -------------------:_-_ _ --_--__--__-.__._ .__-___-.__. This Permit Expires 1 Year From Date Issued ______ __1�.___ zt 3 - f70 -K2�- Application i's 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. -� JOBADDRESS AND LOCATION__ ---- ----• =- ------ --- A - ----------, "� ----------------------------------- -------------------------------------------- Owner' - Owner's Name--- ,...__ �-6 Phone - ------ --•--------------------- ----- ---------------------- Address -- - --- - --------• i ------- ` Pllone.. _ 3/VZ__ Contractor's Name----------------------_---- ---- s• ------- Installation will serve: Residence Ej—Apartment House ❑R Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units-.'__/___ Number of bedrooms __ __ Number of baths-^3___ Lot size ------__________________-_-__-._ Water Supply:,Public system.❑ Community system ❑ Private [Ertepth to Water Table 14_ it. Character of soil to a depth of-3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: (If yes,dote-----------,-__..__) No �ew Construction: Yes L�ilo [-] PHA/VA: Yes El No El TYPE OF INSTALLATION AND SPECIFICATIONS: f� AIN, (No elitic-tank or cesspool permitted if public sewer is available within 200 feet.) v i `-Septic Tank: Distance from nearest well_ ---------Distance from foundation-_./4 Material-.f ---414x, No. of copartmnts*. -------------------Size-yrs _�!-f �_Liquid depth----y--l----------------Capacify.1�i� ------- Disposal Field: Distance from nearest well.S�_____-.-_Distance from foundation-�d:_____--__Distance to nearest lot line________.--5. •' �� � Number of lines_______--.---_ ____ ---Length of each €inel _�_�d` U -Width of trench------P---------------------------- Type of filter material_! m �f_____ _ __ _ ____ Total length -.Seepageline n Pit: Distance to nearest well____________________Distance from foundation__________________.Distance to nearest lot line_-.___________-._ ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------xDepth--------------------------------- Cess ' poo : Distanccee mSize: f _ -------------------- om nearest well_____________ __Distance from foundation material------------------------------------- F ❑ eter--------------------------------------De th----------------- -----.Liquid Capacity ----------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------.-------._. r' ❑ Distance to nearest lot line- ______-- Remodeling and/or repairing (describe):------ --------------------------_--------------------------------------- --------------------- -------------------------------------------------------- . ------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------- i E I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County :;ordinances, Stp laws, and rules and reg lations of the San Joaquin Local Health District. fE(Signed)---------------- ------ -------- --------------- ' ---------- ------------- - - ------------- -------(Owner and/or Contractor) By-------------- ---------------------- ---------- ~?`�---------E------------------------------- `(Tifle) (Plot plan, showing size of lot, location of system in/relation to wells, buildings, etc., can be place on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED Y---- -f-. ----------- ----------------------------------------------------------- ------------------------------------------------------- DATE_- ;,?------laY_�� ---------------- REVIEWED BY - '�- ->------------- ------------- -------------------------------------- DATE--- _ _`_/,5 -------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------. DATE------------------------------- ----- ------------------- Alterations --- -------------Alterations and/or recommendations-------- ------ --- -------------------------------- -----•I---------------------------------------•-•-------• •---------------------------- ------------------------ ------------------------------------------------------------------------------------------------------------------•---•----------------------•---------- ------------------------- -------------------------------------------------------------- ---------------------------- --- ------------------------------------------------------------ ------------- --------------------------------------- ----------------------------- -------------- ------------------------------------------- ----------------------------------------------------------------------------------------------------------------- ------------------ ------------- --------------------------------------------------- - ----- ------ ------------------- ------I--------- ------------------------------------------ - ----------------- - ------------------- INSPECTION BY:.. Date- � --------------------------------------------- FINALSAN 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 i r•.a.c o. 1