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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, JOB ADDRESS AND ATION_,Sa _. �+LC�-y-.G ,- -:1 Owner's Name------ -------- --------------------------------------------------------------------- Phone------------------------------------ Address-•----- --- ---- Contractor's Name--- ---"'-'---- ----- ----- -- -------------------------------------------- Phone----------------------------------- installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other,M/Yp6_,L ii ,0-/e P"e_2 Number of living units: ___-I Number of bedrooms _y Number of baths _-l.-_ Lot size ---------------------------------- Water __-___.-_____________________Water Supply: Public system ❑ Community system ❑ Private Id" Depth to Water Table ........ ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam ❑ 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. Septic nk: Distance from nearest well-__45�e_ ____Distan�e from found tion__.lD_�_-_-_..Material-.---9401) �-�__-_-______ No. of compartments_--__ -----------------Size3__�_�--__Xj'_-.Liquid depth_-.-3E__-._.___-________Capacity---�oL+V--_ Dispos P Field: Distance from nearest well___��•-?_-�-_-_Distance from foundation____Ld_p____-__.Distance to nearest lot line_--_--_-..__. Number of lines----------�- -------------------Length of each line_____�a-._____.__------Width of trench--_ -.�____ __-._.---__________ Type of filter material-_-___ _!._I-----Depth of filter material-------tI__--..____Total length___---t_b 6__-�_________________ `` i ----------- s Seep e Pit: Distance to nearest well-___(--60--------Distance from foundation----tr_P_.____ .Distance to nearest lot Iine,S------.----. Number of pits--------- ---Lining material------�•R--------Size: Diameter-------3a.........Depth---'—'--S`------------------ (� Cesspool: Distance from nearest well_----------------Distance from foundation--------------------Lining material-------------------------------------- ❑ Size: Diameter- --- -------------------------- ----Depth-------------------------- ------Liquid Capacity----------------------------gals Privy: Distance from nearest well- __________________________________Distance from nearest building-----------------------------------.._-_. (�(� ❑ Distance to nearest lot line------------------------------------ ---------------------------------- --------------------------------- Remodelingand/or repairing (describe):--------------------------------------------=--------------------------------------- -------------------------------------------------------------- --•------------------------------------------------ ----------------------------------------------------------------------------------- ---------------------------------------------- ----------- ------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•----•--- ----------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat ws, and rules and regulations of +he San Joaquin Local Health District. {Signed)-------- ----=------ ---- and/or Contractor] BY:----(_6�_ -----1Z-�p I -- ---------------------------------------------------(Title)----------------------- ----- ------ . . (Plot plan, showing size of lot, location of s tem in relation to wells,�liuildings, etc., can be placed on reverse side. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ----------------------------------------------------- DATE___'V__-?- Z -C-------------------------------- REVIEREVIEWED WED BY-------------------------------- -----------------------------------------------_------------------------------------------- DATE-----------------------------------•---------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------ Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------- -• ----- --------------------------------------------------------------------------------------------------------------- ---------- -------------------------------- ----------------------------------- ---- ------ ------ - ------------ ----------------------------- -2-2,1 &/ FI INSPECTION BY; ----------------------- Date -- - - -- ---------------- --- ---- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.L;O. s