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OR OFFICE USF3U r,l 17 -- ,. 3 APPLICATION FOR SANITATION PERMIT Permit No ----------------------- ---------- -f ---- 1�--'-r- -------------- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From 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 with County Ordinance No. 549. N". t 3. JOB ADDRESS ANQ TION' h----�-�3----------- -- -- �------------------ -------------------------- JOB - Phone-----------•--------•-------------- ---------- --- Owner's Name --------- -..----•---------------- -------- - -- . .t------"� ---------------------------- Address IPhone-------------------•-------------- Contractor s Name__""- _ C�"-_ �""""","--- - -- Motel Other ommercial Trailer Court ❑ ❑ ❑ Installation will serve: Residence, partment House ❑ ❑ . Ara = � Number tf living units: "/-." N ber of bedrooms ""- "." Number of baths -L- Lot size __. �---. -- --. r Water Supply: Public system Community system Private [] Depth to Water Table _ ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �-rrdpan ❑ Previous Application Made: (If yes,date-------- --- -----I No New FHA /VA: Yes E] No Construction: Ye ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well-__" ---_Distance from foundation_f"/_ "---_----__.Materi4-,�"___.r:--_-_--_------------------------- Septic T �/ / 4, c1 Li uid de fh-------e_ --- -- ----Capacity =------------- No. of compartments_."--_,�___.-___.".___Size-�_""�---•-`�,--- q p• ;". C1 Distance to nearest lot Disposal d: '� Distance frorn,nearest well.-_,�-----Distancefrom foundation_"- ._"""___."-_-. Number of lines""=-_-I _ Length of each, line �_�-o ". ��--W�dth of trench__._ __ - ------------ ` a, ...- �� Type of filter materrG-"1C----------Depth'of filter material__. -Total leng#h"_". �"""-_---------1----- c� f ----- Seepa Pit: Qistance�,to nearest well___ .". _""""--Distance rom foundation__--___- Distance to nearest loft life". W Linin material__+ �LK/-----Size: Diameter--_"- ----- -- Deptn"-, _-.0 -- 6 . Number of pits- - #' - - g r Cesspool: Distance from nearest well----------------Distance from foundation-------------------.Lining material""._______" "----- ❑ -- gals. Size: Diameter---- --------- - = ------- ------.Depth----------- ---------- ---------- ---- --------- -Liquid Capacity- -,° -------------------•-g u. i --- ` - --------------Distance from nearest building--- ------------------------------------- 1 K Privy: Distance from#nearest well_________________ _ ❑ Disfarice to nearest lot line----- -----= a- ----------------------------------------------- C ------------------------------------ -------------- •------------ I � ' I Remodeling and/or repairing(describe--------------__ --------- y --- ------------ --I-- ---- -------------------------------------------------------------------------------------- -----? ---------------------------------------"--------------------'-----------------------------"__-------------------•-`^-------- --------- -------••---- ----------- - -p p application I her eb certifythat l have re ared this a lication and that the work will be done in accordance with San Joaquin County ordinances, State law , drules and reg ns of the San Joaquin Local Health District. ---_---__ ..___---(Owner and/or Contractor) ---- ----- - (Signed) ---- --- ------- --- -- " R (Title)- ---- --- --- --- (Plot plan, showing size of lot, iota do system in relation to we buildings, etc_, can be placed on reverse si e). I I FOR DEPARTMENT USE ONLY — - APPLICATION ACCEPTED BY-_ ." - DATE--�1 r f REVIEWED BY--------------------------------- ----------- ----------------------------------------------------------------------------- DATE----------------------------------------------------------- DATE .,----------------•---------------------------------- BUILDING PERMIT ISSUED-------------------------------- - i DATE--------- ------ - ------ ------------------- ----------------- ------------ Alterations and/or recommendations: --/7✓ r w� "" l a--- -�l� L --- -----►---- ----- --------- �f � ` °'` ` ' ve --- �`�----------------------------- ---------------- ------ ------- --------------------------------------I-------------------------- --------------------- -------------------- FINAL ---- - FINAL INSPECTION BY:------- - ----------------------------- Date �� = �-' lo '` ------------------- t 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 r.v.ca. LS