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FOR OFFICE USE: 2Cs01 (�,: ( 0t-°tk-- �;1-0 015 ------ -------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .Iffq�0.. ------- ----------------------------- ------------ (Complete in Duplicate) Date Issued _..__ _____ _____ ____ ___.__ IThis Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wor herein described. This application is made in compliance with County Ordinance No. 549. r/41Q4ya a/a f, slim �ff�e lP Oa JOB ADDRESS AND LOCATION..__ 1,dX___, _Gf. FF,r.Tirl.7�_(/ , . �r� Z1 j!/i/�_. '✓�°t' �i Owner's Name ��-_L �'.'l0sISfi ------ ------------------------------ --------------- ------------------------- PhoneJ---$ _11,3, Address--------------- ------------------------------------------------------------------------------ = .............. Contractor's Name_" r3 �'_ _q�/'*"_ .�1� � •fie• - Phone.IVK4 �_48�/----- Installation will serve: Residence t3- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ ----- Number of bedrooms _______. umber of baths __I.._• Lot size ----------------------------- Water Supply: Public system ❑ Community system P Private ❑ Depth to Water Table _:._.... ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No P--FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well_________________Distance from foundation--------------------Material_.____..____-_-_____--.----_-_____-____-__._-___. No. of compartments--------------------------Size---------------------------=---Liquid depth--------------------------Capacity----------------------- D' o Distance from nearest well_1x5_L?_.__Distance from foundation....lQ-----._..Distance to nearest lot line---- -------- -------------- Number -- _- Number of lines---- ._______._. _ __._Length of each line_1._Q_®-�___-__-___. Width of trench.___��+ ��_____.-________ GtC� Type of filter materials _ __Depth of filter material____. _9�-_____Total length________________ ( .�._.___.___ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-------.-_---._.- ❑ Number of pits---------------.------Lining material--------_.__ ------ _Size: Diameter------------.----------Depth_________________-_______-.-_ O Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--------------------.__--._-__.-__--_ d ❑ Size: Diameter-------------------------- ----------Depth---------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-----.-------.-----------------------------------Distance from nearest building-------------------------------------- F-1 Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------•-- ------------------------- ------------------------ -------------------------------------------------------------------- - --- ------------ -- ---------- -------------------------------------------------------------------- ---------------------------------------------------- `` grnM ---- --°�------- �" � �1----------------------------------------------------- ---------------- -- - - -- ------------------- ---------------------------A--------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St4e laws, and rules and regulations of the San Joaquin Local Health District. (Signed) 1---------- 'I r�► 'k.�l--. .t^ (�� --�-- - ntractor) By:------------------------------------------------------ --------------------------------- -----(Title)------------------ ------ -------------- -- --- --------- (Plot plan, showing size of lot, location of system in relation to Is, buildings,�e ., can be placed on reverse side). I FOR DEPAR ENT USE ONLY APPLICATION ACCEPTED BY. ---------------------------------------- DATE------------------------------------------------------- REVIEWEDBY-------------------------------------------- ------- ------------------------- --------------------------------------------- DATE------- ---------------------------------------------------- BUILDINGPERMIT ISSUED------------- ----------------------------------------------- ------ DATE-----------------------------I------------------------------- Alterations and/or recommendations:------------------------------------------------------------------------------ -----�---------------------------------------------------------------- __________ __ _______------------------------------------------------------ \•t-. _ .__F _-_--_._-_-_ .. __ -------------------- _____--_ 7L _____________--------------________________________________________•n._..------------------------------------------------------..__.--------------------.------------._..._____......._....._.___.___---___-.--_---.-.-..__.-- FINAL INSPECTION BY:..--_ -- -- __ J 4 -- --- -------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California