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'FOR OFFICE USE: . `.----- - -'/r---- APPLICATION FOR SANITATION PERMIT Permit No. ..................... -------- ---- -------- ----------- ------------- (Complete in Duplicate) Date Issued --- ------------ This Permit Expires I Year From Date Issued - Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION----------------- ------- U-------- -------------------------------------------------------------------- Owner's Name--- ----------------- r�------ht?oaa------------------------------ - - --------------------------- -------------- Phone---��;---- .Q r Address------------ -----------------Lglp-------- ------------------------•----- ---------------------------------------------------.-...-----------------•-•------------ Contractor's Name------------------Roy----- —--------------------------------- -----------------•---------- ----------------- Phone----------------•-•-----••--------- Installation wile serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ a-cNumber of living units: ___L_ Number of bedrooms _�--- Number of baths -- -- Lot size ------- p-----1 ---------------- Water Supply: Public system Re Community system ❑ Private ❑ Depth to Water Table 80_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El'Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No � 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.) f Septic Tank: Distance from nearest well_ .-Distance from foundation----ld-------- Material-�6Cf-Lt __________ ----------- ❑�i571t-'� No. of compartments----------�----------Size---------------------------------Liquid depth--------9�-----------Capacity--- � �� Disposal Field:? Distance from nearest well.................Distance from foundation--------------------Distance to nearest tat line----------------- ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench--------------.--------------------- Type of filter, material---------l------------------Depth of filter material----------------------- _ Total length--------------------- I Seepage Pit: Distance to nearest well__&,Vgn-----Distance from foundation-__44?-_________.Distance to nearest lot line_____ �c� _ ------- Cesspool: I [ Number of Pits------------I.-------Lining material----------- -------Size: Diameter----.34~---------Depth--. -----------------__ Cess ool: Distance from nearest well-----------------Distance from foundation---------------_...Lining material------------------------------------- v' ❑ Size: Diameter--------- ---------------------------Depth--------------------------------------------------Liquid Capacity--------------------- gals. I Privy: Distance from nearest well -------------------------------------------------Distance from nearest building------------------------------- .__-___. . ❑ Distance to nearest lot{Bine------------------- -------------------------- - ----------------------- ---------------------------------- ---------------------------- ----- Remodeling and/or repairing {describe}:_...VS'n __Th_Goy1' r ` S 1)iw_ ToiP�--------------------------------------•-------------------------------------------------------------•--•------------- ------------------------------------------------------------------ ----------------------------------- --------- --------------------------------------------•------------------------------------------------------------------------------------------------------------------- --------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta ws, and rules and regulations of the San JoaqufLLojI Health District. ( wner an / r Contractor) ---- ----,----(Signed) By:-------- ---------------------------------------•------------------------------------------- ------------------------ ------(Title)---------------------------------- - - - ----------------- (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.------------c�-=e--9— -.------------------- - - --- ----------------------- DATE REVIEWED BY---------- ------- -- - ------- ------------------------------ ------------------------------------- ------------ DATE.-------- ------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------- Alterations acid/or recommendations:---------- *------- ----------------------- ------------------------------------------------------------------------------------ ---------------------- ---- icMm ,de �" ?z - -�r _. - = =�0=------------------------------------------------------------------------------ ---nk 'weet---- ----------1--4_40------------------------------------------ ------------------------------------r------- -.- - ---------- ------------- --- ---- ------------------------ FINAL INSPECTION BY------ -- ----------- ------ --------------- - � SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haseltort Ave. 300 West Oak Street 1,24 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California