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FOR OFFICE USE: 4_- . -4 -------------------;i----------- - APPLICATION FOR SANITATION PERMIT Permit No. _0 ..................... -------------------------------------------------------- - ----------------------------------- -------------------- (Complete in Duplicate) -� .......................................................... This Permit Expires 1 Year From Date Issued Date Issued .- -5?�:4K7:4Z Application is hereby made to the San Joaquin Local Health District for a permit to construct and install a work herein desc bed. This application is made in compliance with County Ordinance No. 549. i6 yr JOB ADDRESS AND LOCATION... ,5/y/.;-.....1 .-I;-- -er---- e .-'.... Owner's Name./------- "--- ---------------- Phone-•---------•--------------------- - Address /�1`: _.. ..7`."� -_ _� _............5'1 os� d --------------------------- Contractor's Name----------- Z,,Z.96✓-;s..—--------------------------------- ------------------------------------------ Phone----------------------------------- Installation will serve: Residence {Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms ..J--- Number of baths P?... Lot size --_____________________________ Water Supply: Public system ❑ Community system ❑ Private 2j'—Depth to Water Table i6�_O ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 21-11'ardpan ❑ Previous Application Made: {If yes,date____________________) No Er"—New Construction: Yes ❑ No Er FHA/VA: Yes Z�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 welf----- ---------Distance from foundation--------------------Material-...-...-....-._......_._.__.__.___.__--------- on � Sfi/th No. of compartments------------- -----------Size--------------••----------------Liquid depth------------ --- ---------Capacity----------------------- { Disposal Field: Distance from nearest well....-------------Distance from foundation--------------------Distance to nearest lot line----------------- � < g t Number of lines-----------------------------------Len Length of each line--------------------------.--.Width of trench.--.---------,--•------------___--- Type of filter material-------------------------Depth of filter materia----------------------- length._..-.--.__-_-__._--..--------_------_---- ;V1 Seepage Pit: Distance to nearest well..1_0---_---Distance from fo ndation__-� --------;Distance to nearest lot hne.jc............ [� Number of pits. . _____________Lining material./�/�. ...Size: Diameter_-? Depth�®1__ ✓e'--.- ' r Cesspool: Distance from nearest well----------- --Distance from foundation____-----------__Lining material---------------------------------------- i ElSize: Diameter - Depth - __-------------------Liquid Capacity---------------------- •-gals. Privy: Distance from nearest well----------------.--------------------------_-----Distance from nearest building.. ------ ---------------------------_.-. ❑ Distance to nearest iat line - --- ----- ---------------- - ------------ - ---------------------------------------•-------1----------------------------------------------- Remodeling and/or repairing (describe)------------------- - ---- --- �' -. ------- �7-------5 , --------- - -------- --------------- -------------------------------------------------------------_-------------------------------------_-------------- ---- --------- /3a`. lGl�' � --- ----------- -- ------ ------------------------------ --------•---------- --------------- - -- ----------------------------` - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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 rules and regulations of the San Joaquin Local Health District. l { �y, � (Signed) Gr r/ - ---------------------- ( r Contractor) z -__Title �- i (Title) i (Plot plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY Y APPLICATION ACCE=PTED BY---------------- --------------------------------------------------------- DATE--------- _� _ REVIEWEDBY------------------------------------------ - ----- ------ -------------------- ------- -------------------- ----------------- DATE---------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------ Alterations and/or recommendations---------------------------------------------------------------------------------------------- ------------------------------ ----------•----------------------- 1 ----------.-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------_----------- --------------------- ---------------------------- -...,---------------..-_...-..----.-....------------------------------...-.__......._..---...---------------------........-------------_---.-............. - r� *44.14_6 /r'� ry f I FINAL INSPECTION BY:-------- -----------4-1-t-4----•---------------- Date----------------�---- -- .1 ---5!...----------------- ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California } Tracy,California F.P.00.