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FOR OFFICE USE: - ----------------------------------------------------- -- APPLICATION FOR SANITATION PERMIT Permit No. C ' ----------------- -------------- ----------- ------------ (Complete in Duplicate) Date Issued ------------------------------------------ This Permit Expires I Year From Date Issued ' Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereipl escribed.- This application is made in compliance with County Ordinance No. 549. • 544- A �` � -�g s'109 JOB ADDRESS AND LOCATION--y- =`�_- ------- Owner's Name------- - - - -------F -- -- - --------------------------- - - ---- -------------------------------- - Phone--------------------------------- Address----------------• `---------- •--•---------------------------------- •---•----------------------------------------------------------------------- ------ , Contractor's Name----- -------- / -• ----------------------I------------------------------------------------- Phone--------------------=-------------- Installation will serve: Residence �Apartme t House ❑ Commercial ❑„ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _____ Number of bedrooms _._ Number of baths ______ Lot size _ i /' j � P�°��-,� i�,��---=----------------------- Wafer Supply: Public system ❑ Community system -❑ Private ❑ Depth to Water Table &-ett. Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam ❑ Clay Loam.❑ Clay E] Adobe Hardpan El t-- Previous Application Made: (If yes,dote._"----------------) No New Construction: Yes ❑ No Ra- FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: k - =(No-septic tank-or-cesspool-pe'rmittedrif,publicsewer,is.available.�within 200rfeet.) Septic Tank: Distance from nearest well-,/a-g9-Distance from foundation_Z�J p--------Mat�r�l_ _5�ie, ----------------- (�r No. of compartments----A------------.- _Size �10____ '`?__Liquid depth.. ____ ---------Capacs#y C _ ____ 101 V1 Disposal Field: Distance from nearest well_/APff__/Disfance from foundation_-Q__------Distance to nearest to line./,O__._._:_ Number of liengfh of each line____ _._____'------Width of trench_A�_______________________________ �� , , T e of filter mat yp erial � _ pf- Depth of filter material-_� _. _ .__Total length____ fes_._._________________`____ Seepage Pit: Distance to nearest well____� �___"Distance fro foun .afion__j. ____.-:Distance to nearest of Ii�e.lQ________ Ni mber-of pits------/-----------Lining material---o' Diameter. __.,_...__.Depth al�_._�� e ',—A Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- 0 ❑ 'Size: Diameter------- -----------------------------Depth-------------------- ------------------ ----------Liquid Capacity----------------- ----------gals. Privy: Distance from nearest well--------------__.------------------.--------------Distance from nearest building----------------------------------------- ❑ - -- Distance to nearest lot line ----------- - -- -- ---- =--- ------------------------ �- - -- ------------------------ ------------------------------ rib ------ -Remodeling and/or repairing (desc ---------------------- ---------------------------------------- - ------------------------------------�----------------------------------------- - G _ ---------------------------------------------------- r ---- ------------------------------ ------------------------------------------------------------==---------------------------------------•---------------------`---------------------------------- �i ------------------------------ ------------------- --------------------------------•--------------------------------------------------------------------------------------------------------------------- --- --- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and arulearegulations of the San Joaquin Local Health District. - -------------------- ------------------------- ----(� Contractor)'b (Signed) a _ — - - -- __ ,..- - ---.:._--x _B -�_ �-- -` --�'—�=-==------ � - --� = = -- ----(Title)=- ��''�---�----'T..:-- ------------- ------------------- " '�'�. (Plot plan, showing size of lot, location of system in relatio wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED '=C_�1?i d -�J----- --------------------------------------- DATE 5 � r - f REVIEWEDBY--------------------------- --------- ---------- ----------------- ---------------------------------------- DATE------------------------------------------------------------ t BUILDINGPERMIT ISSUED------------------------------------ -------------------------------=----------------------------------- DATE-------------------------- ---------------------------- Alterationsand/or recommendations ------------------------------------------------------•------------- --------------------------------------------------•---------------------------•----------- 1 --------------------------- -------------------------------------------------------------------- -- ------- ------------------------------------------------- ------------------------------------------------------ --- ------- ------------------------------- ----------------------------------------------------------- ------ -------------- ----------------------------------------------- --------------------------------- FINAL INSPEC Date------- = d ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E..Haselton.Ave. 300 West Oak Street 124 Sycamore Street ' 205 West 9th Street Stockton,Cdlifornia ,.. ' F' Lodi,California + Manteca,California yx Tracy,California