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-----------..................................____._____. APPLICATION FOR SANITATION PERMIT Permit No. ...f..�.1-1 7 f{ ---------- -------------------------------- ---------------- (Complete in Duplicate) --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued ._l_: ......._._._ 66 2 tO -O'z-- Application is hereby made.to the San Joaquin Local Health District for a permit to construct and install the work herein described. _TIAs application-is•made in.,_compliance with County Ordinance No. 549. .. . V7-"JOB ADDRESS AND LOCATI0N..._1/ i_ .Y.... 4?. . ... ----------••-----------`---•-------•-- r` Owner's Name_.._ .:. ................................. Phone.................................... Address------ - ---------- 3a..........................•A-7 ------•-•--••-•-•-•-•--•-••....._....-----------••-------•--...........----••-•-------.•-••------------ h Contractor's Name.... .. Gs✓t ir! -�nv--------------•-----------------•-------............................................ Phone................................... Installation'will-serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of diving units: ........ Number of bedrooms ........ Number of baths :_q.:-Lot size ...kn.7.... ....................... Water Supply: Public system ❑ Community system ❑ Private 14 Depth to Water Table.ye.e. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam IV[ Clay Loam ❑ Clay F] Adobe[3 Hardpan [j Previous Application Made: (If yes,date____________________) No ® New Construction: Yes No ❑ FHA/VA, Yes ❑ No ❑ TYPE ,OF INSTALLATION AND SPECIFICATIONS: cess ool-�ermitted`if'ubhc sewer is evadable"witkin 260-fief) - Septic Tank:' Distance from nearest well__�_� -J.' .um. --� - -. . ...Distance from foundation__p................Materiel-----. ....-.-----... .................•-..• [� No. of compartments..__A�t.................Size_..ai_10t-91....._Liquid depth....__I................Capacity.... ...... Disposal Field: Distance from nearest well-1.1-5------Distance from foundation_ ).............Distance to nearest lot line..47_1___ h Number of lines...... .: _ _ Length of each line_____�_0__ Width of trench....�.V'�----------- Type of filter material -_ Is .Depth of filter material_--_ _ _____.....Total length.... a_..____...•... --•............. Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line................. ❑ Number of pits------r...............Lining material.......................Size: Diameter...................__Depth................................. Cesspool: Distance{fromnearas+well.................Distance from foundation....................Lining material..................................... ❑ Size: Diameter---------------------------------"`..Dept h-"-.................................................Liquid Capacity............................gals. Privy: Distance from nearestwell_ _______________________-_-___L.7._Distance from nearest building.......................................... f_1Distance to nearest lot line. ----- ------ t-----`---------- -'..... ............................................•..........--•-•............................... Remodeling and/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 k ordinances, St laws, nd r and regulations of the San Joaquin Local Health District. (Signed- . . ----••------------------------------------------------------._-_---------------(Owner and/or Contractor) ......_... .�.. � 1. (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i s FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- ---------------------•-------•--------------------- DATE.. rj-.:T _..__... i. REVIEWED BY--------------------------------••-------------------------------------------------------------------••-------------------- DATE._....._...----------------------------•-• BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------- •--------------------•-----...:-------------------- Atterafions and/or recommendations:--------------- •---------------------------------------------------------------........-----•-----------------------------.-....--•------------------------- ------------------------------------ ...:_. .---------•--------- ---------------••---•---------- --------------------------------------------------------------------------------------------- FINAL • -- INSPECTION BY - -- - - �x SAN JOAQUIN LOCAL HEALTH DISTRICT ' 130 South American Street 300 West Oak Street 144 Sycamore Street 405 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REv16ED 8-99 YM 5-61 AtLAS