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FOR OFFICE USE: w F = 3 ., - ------------------------------------------------------ - - APPLICATION FOR SANITATION PERMIT Permit No. ----------- (Complete in Duplicate) ------- r This Permit Expires 1 Year From Date Issued Date Issued 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 ith County Ordinance No. 549. OB ADDRESS AND LOC ION ------------ I Owner's Name--- __-- - _ -- -------------- --------------- - --------- - ---------------------------------------- Phone_ :!_ Address ----- --- -- �----------------------------------------------------•----- .-..-------- Contractor`s Name. �4.f-r [ = Phone.�(� ..3x' Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel E] ,Other ❑ Number of living units: _4CP_. Number of bedrooms _c;�_ Number of baths _ Lot size -----C��.___ `► ' ---=------------ Water Supply: Public system ❑ Community system ❑ Private D, Depth to Water Table/s 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----- -----;--------I No ❑ New Construction: Yes ❑ NOX FHA/VA: Yes ❑ No ❑ TYPE„OF.INSTALLATION-AND SPECIFICATIONS_ _- ....._--. T �` (No septic tank'o esspoolpermitted if p—Mic seweris avaiiabl'ewithin 200 feet.)"` k- pti ank; Distance from nearest well-----------------Distance from foundation--------------------Material----._--____-------------__------._________--._-. No. of compartments------------------------Size--------------------------------Liquid depth------------------------. Capacity-------------- Disposal Field: Distance from nearest well_±5..... _Distance from fcundafion/0----------.Distance to nearest lot line-. --_--_ ICY Number of lines-------1--__._.____ ___ . Length of each line---------- AVIS--------Width of trench___.__� __.___�.__.___. Type of filter material__a�-1_AQ-�C-_Depth of filter material____�%8_-____--.Total length_-_------____,f�L_-----_-__- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line-._-._____-----_ ❑ Number of pits--- -----------------Lining material-------- ------.Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------.-------Lining material----_._----__-----------__.----..__-. E] Size: Diameter--- ! ------------------------ -----Depth------------------------------ ---- ----------------Liquid Capacity_ -------------gals. I .Distance from nearest building Privy: Distance from nearest well--------- ------------------- ------ ---- g---------------------------------------- Distance ---------- ------------- ------- - ❑ Distance to nearest lot line----------------------------------- -------------------------------------------------------- ----------------------------------------------- Remodelingand/or repairing (describe):------------- ---------------------------------------------------------------------------------•-----------------------------------------------------.. ----------------------------------------------------------------------------------------- ------------------------------------------------------- I - - - -- ------ -------------------------------------- -------------------------------------- ---------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S to laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------------ ------ ......... ------ ---------------------------------------------- V1_ (Owner and/or Contractor) it: . .BY=------•--------_-- = - -----`-- ----- ---------------------------------------------(Title) - (Plot plan, showing size of lot, location of system in lation to wells, buildings, efc., can be placed on reverse side). T i1 FOR DEPARTMENT USE ONLY kJ --------------- APPLICATION ACCEPTED BY------ ----------- --------------------------------------------------------- DATE------- --1/`C� S REVIEWEDBY-------------------------------------i---------------------------------------------------------------------------- --------- DATE_------------------------------------------ ------ ------------ BUILDING PERMIT ISSUED---------------------------------------------------------------- -------------- ----------------------- DATE------------------------- Alterations and/or recomm dations:.------�L7 M-RF10------J3F--r - � � �'- ------- ------ --------1O�T[-U_-�------PA m�.------f# i�l_I -W_4----t---------------------------------------------------------------------------------------- ----------' 4- -,- -----------------•----------------------------------•------------------- L FINAL INSP - --'±-- Date---------------4r.,0------- _1.....6.5 - --------------------------- 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