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FOR OFFICE USE: ----------------- -=------------------------------------- ----------------------------______.___--------.-_-_----- APPLICATION FOR SANITATION PERMIT Permit No. ...�. ..._... . � ---------------------------- -----------•----- (Complete in Duplicate) Date Issued -------------------------------- This Permit Expires 1 Year From Date Issued .--._.._l_..... _.0 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 ANO TION y ------------ - ---------------------------------------------------••-- Owner's Name.--------- -------•-------------•-••----------------- ------------------------------------------------------------ Phone------------------------------------ Address 3 3S✓ `5 ------Contractor's Name.._ ------------------7-3__....-------------- ----- .---•-• ------ Phone------------------................. Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: --,_-- Number of bedrooms . -- Number of baths _/.... Lot size .-- - 1l Q.J------------------------------ Water Supply: Public system ❑ Community system ❑ Private Yr-16epth to Water Table h_-_ ft. Character of soil to a depth of 3 feet: Sand [']Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,dote--------------------) No ❑ New Construction: Yes p o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well%)_Q.r---------Distance from foundationt .............Material.---------p-n-C-y^- - e............. ELNo. of compartments-..--z----------------Size-------- --------Liquid depth_.-_4/ -----------------Capacity__ a Disposal Field: Distance from nearest wp�ll- -------Distance from foundation....1rp...... Distance to nearest lot line--.:?dr./-.... E9__ Number of lines-----------------------------------Length of each line---------3ff_..............Width of trench.-o'Z.(,--°---------------------- Type of filter material---_�!- -' _-._--Depth of filter material --------/g.........Total length------- ......---_--__............. Seepage Pit: Distance to nearest well-------------------__Distance from foundation--------------------Distance to nearest lot line----.---.-_-.--.. ❑ Number of pits----------------------Lining material--------------.--------Size: Diameter-----------------------Depth-----------------.--------------. (— Cesspool: Distance from nearest well---------------_-Distance from foundation-_-----------------Lining material-.--------__----__-.-_-------------... ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building------..--------------_----__------------. CA ❑ Distance to nearest lot line-------- ------------------------------------------------------------------------------------------------------------------------------------ Remodeling and/or repairing (describe): --------�1:#"Y-------56 -- '� _:---��r-' ....!-_-,A-,--- ---•�I�".?__�i---- f .,E. ...._---•............. ---------------------------------------------------1----------------------•- b ---------••-------------------------••----------------4--i--••-------------------------(------------- w ----------------------------------------------------------------------------•----•-----------------------------•------•--------.•----------•------------------------------------------•---------------------------------- I hereby certify that I have prepared this ;plicafion and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulati0of a San Joaquin Local Health District. (Signed)------------- -�• --------- --------- -- ------ - -----.- ----- ---------------------------- � {Owner and/or Contractor) BY•----------------------------------------- - ---------------------------------------(Title)---------- ----------------------------- --- - -- ---------- -- ------- - ----- ------------------------- (Plot pian, showing size of lot, locatio o Sys in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - DATE -�'.F f -R _..... . 3.••--�•_.____-.__. t REVIEWEDBY------------------------------------------------------ ----- ----- ----------------------------------------------- BUILDING ------------..._-.-._. BUILDING PERMIT ISSUED--------------------------------------------------- -------------------- ........................... Df4TE----------••-------------------•- -----•-•------------------- Alterationsand/or recommendations--------- ------------------------ --- --------------•--------------------------------------------------------------------------------------••-•--------------- ---------------------- ---- ---••------------11---------- ---------------------------------------------------- -----------------.----•----....--..------------------.---------------------------------------•...... ---------- -------------------------- -----------•----------------•-------•----------------------------------••----------------------------------...-•----------------------------------------•-------.- --------------- Date -------------Date FINAL INSPECTION BY----------- --------------- J SAN II JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California f8.9 REV16Eo 6.59 C.P.b b.3M 5.5b I