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FOR OFFICE USE: -------------------=---------- -- - ------------------- ..................---- --- --- -------------- ----------- APPLICATION FOR SANITATION PERMIT Permit No. .� ----- - -------- ------------------------------------- (Complete in Duplicate) __...._._.___ This Permit Expires 1 Year From Date Issued 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. OS 3 _ p k�O _ 27 BSc Al . — -ry '-c P-04 JOB ADDRESS AND LOCAyTION__ s .,.,r_r'��,-• s . .a� loor Owner's Name--------4----- d—----------- ------------------------ Phone------------------------------------ Address 3_0 --- -------------------------- �-, --------------------------•------------------------ All Contractor's Name-----J' ..... ------------------------------------------ Phone Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1---- Number of bedrooms _ ___ Number of baths _ ____ Lot size _________________________________ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 4 Clay [] Adobe ❑ Hardpan Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ {!� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) o� Septic Tank: Distance from nearest well_$�6_.___..__Dista n e from oundation__./?_---------Material_ _ _ ----___ ___________ ___------------------- . No. of compartments-----o ______---------Size__ _ Liquid clepth---- __ __._._---- p___-Ca acitY--------"�' -�-e -- � Disposal Field: Distance from nearest well..5'0--------Distance from foundation---- d-------.Distance to nearest lot line__'_________.. Number of lines-_______ _._ 4' Length of each line____ _ Q _________Width of trench.__ ` _______-.____.__.____ Type of filter materia- --Depth of filter material___.l9.�F..______-Total length___ .Q ! ________________-___ r ` ® ` Seepage Pit: Distance to nearest well___, ______Distance from undation_--�_____ __.___.Distance to nearest lot line_________ Number cf pits-__t�`__--.___._.___Lining material___----.Size: Diameter__-___ _- RP Depth---_�1 7* -�------------------- Cesspool: Distance from nearest well--------------_-_Distance from foundation-------------_..._Lining material-------------------------------------- El Size: Diameter- --- -- ------------------ ----------Depth----------- ----------------------------------------Liquid Capacity----------------------------gals. r Privy: Distance from nearest well----------------------------------------- _-___.Distance from nearest building. ----------------------------__..--...-. ❑ Distance to nearest lot line--- ----------- ----------------------- ------------------------- ---------------------------------------------------------------------- Remodelin and/or repairing (describe):-- ;___ _ : ________ _ 9 / p 9 ( "! ,�10- — ---------------------------------------- -- ---------- ------------------------------------- ---- - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------.-.- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State Id rules and regulations of the San Joaquin Local Health District. (Signed)------------------- . ��.S -. -----------------------------W--------------- ---- - ------ ------ Ow rand/or Contractor) By: (Title)_ ............ (Plot plan, showing size of lot, location of sys+e in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE_ r REVIEWEDBY------------------ ------- ------------------------------ - ------------------------------------------ DATE---.P. �-4e BUILDING PERMIT ISSUED--------------- ------------------------- ---------------------------------------------------- • DATE__ Alterationsand/or recommendations:------ ------- ------------------------------- ------•------------------------------------•----•------•------------------------------------- i -------•-------------------------- ----------------------------------------------------------------------------------------------------------------------------•- -------------------------------------------••------------ ------------------------------------------------------- ----------------------------------------------------------- ----------------------------------- FINAL INSPECTION BY:.. Date---- x SAN JOAQUIN LOCAL HEALTH DISTRICT r 1441 E.Ha:alton Ave. 300 West Oak Street 724 Sycamore Street '205 West 9th Street l Stockton,California Lodi,California Manteca,California Tracy,California I s - - F.P.Ca. l