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qy FOR OFFICE USE: Iy-------------------------------- ------ - f ! APPLICATION FOR SANITATION PERMIT Permit No. _ ..C�� , i ------ ----------------------- - -------- � ------------- -------------:--------- --- - -------- ----- (Complete in Duplicate) Date Issued —. G r ------------------------------_--------_-_- This Permit Expires I Year From Date Issued. I Application is hereby made"to the San Joaquin Local Health District for a permit to construct and install the work herein described. This_application T'is made in compliance with County Ordinance No. 549. a r JOB ADDRESS AA LOC AT10 � -7-02EZ(,::,7P0( Owner's 3 Name----- •---•---••------------------------------------ Phone 7 Address -- S 'Cr -•• - --- - Contractor's Name-------------- ------ ---- ------------- ...... - ---:- ------ --------- Phone_----•------------•-------------- I Installation will serve: Residence ❑ Apartment ouse ❑ .Commercial Trailer Court [I Motel [I Other ❑ Number of living units: Number of bedrooms ^'_- Number o -baths _ ___ of size ---------------------_________________--_--_---_____---_ Y� Water Supply: Public system E] Community system E] Private epth to Water Table<18V ft, Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Cla Loam Adobe Hardpanp ❑ ❑ Y ❑ Y ❑ ❑ ❑ k —Previous-Applicat.ion-Made:—Ilf,yes,date---------- .-I No Ej New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ ..� TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) N Septic Tank: Distance from nearest well_________________Distance from foundation-------------------Material-------------------------.------ ------------- _ ElNo. of compartments--------------------------Size----_--------------------------Liquid depth------------------------r Capacity---.- -----------------; Disposal Field:. I Distance from nearest we€I------------------Distance from foundation--------------------Distance to nearest lot line____---_--__--__ ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench------------------------------- Type ------------- --------_- Type of filter material-------------------------Depth of filter mai-erial-----------------,----.Total length----------------------------------� ._ ' Seepa it: Distance to nearest well.__.1_Ad-----__Distance'from foundation___ --�-_--__.Distance to nearest to e__. '_____ Q. I dumber of pits---------tf------------Lining material------ ---Size: Diameter--------4/gr"_---Depth--------------------------------- Cesspool: SD•izea D ame}e nce from nearest well_________________hep+hce from foundation-.-- - _-- _-______Liqur+d Capacity_ ___g material -.---__---�____galsJpI `.. Vt � 1 i Privy: Distance from nearest well-------------------------___-------_----------(Distance from nearest building----__-______-_____________--------_---_.l 1 ❑ 1 Distance to nearest;lot line - ------- ------------------ ---- ---------------------- ------------ a �. ` ' Remodeling and/6r repairing e ----- - ----_ ------------------------- ------- --- ---- -- ------------------- - 1? = = t----- --- p -------------------------------I------------------------- --------------------•--•-------------- --------------------------••-•------------------ --------------------------------------'------------------ --------- I hereby certify that I have prepared this application th6 a-work will be done in arch accordance with San Joaquin County ordinances, State 1 s, and rules and regulations of the San Joaquin! oval Health District. �($igned) _ -------------------------------------- ----- --------------------------- d/or Contractor) = — - - -- By:----- a - ----rc--------- -------------------------- -----[ • --------------- .---=- (Plot plan, showing size of lot, location of system in to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- -- C - ----------- - ---------- ---------------------------------------------------- ---------------------------- REVIEWED --------- ----REVIEWED BY------------------------------- -------------------------- -----------------------------------------------•--- DATE-------------------•-------------------------------•-- ---- BUILDINGPERMIT ISSUED-------------------------------- ----------------------------------------------------------------- DATE------------------------------------------------------------ Alterationsand/or recommendations.------- ------------------ -------------------------------------------------------------------------------•-------•--------------------•----•-•---------- ------- ------------------------------ ---------------•------------------- ----------------- - -----------------------------------•-- --------------------------------------------------------------------------------- -- ----------------------------------------------------------------- ----------------------------------------------------------------------•-•--- -------------•------------------------------------------------•-- ----------------------------------------------- ------ •-------------------------------------- ------------------------------------- ----------------------------------I----------------------------------- ------------- FINAL INSPECTION BY:-- -------------------- Date_ ---------------6--� --- --- ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California' Manteca,Califoinia Tracy, California F.P.C C.