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FOR OFFICE USE: 000-- Toagvm -t Z 1 f ______________._---_-.__..--_________________--- APPLICATION FOR SANITATION PERMIT Permit No. .p`z 130,. ` ---------------------------------------------------- - (Complete in Duplicate) Date Issued --------------------------------------------------- This 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 work herein descried. This application is made in compliance with County Ordi nce No. 549. �] c JOB ADDRESS AND LOCATI N t----------------- �=--------------- r Owner's Nam! r71- ----------------- Address Phone. -----A ---- ....... ---j---------------- Contractor s Name-__---._.. _ �-,: ...:__ .__. Installation will serve: Residence Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms ------- Number of baths ---/--- Lot size ._C�._. .__�__ __ ___________________ Water Supply: Public system E] Community system Private ❑ Depth to Water Table _�2_-__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel Sandy Loam ❑ Clay Loam ❑ Clay)y Adobe❑ Hardpan Previous Application Made: (If yes,date_-_---------------) No New Construction: Yes X 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 Tank: Distance from nearest well--A2 Dist Vcg fro pundatLon____1_4_---___.Mat nal-__._ 1A No. of compartments-___ .. ___--_-.-.__Size______ _______ ELiquid de th-_._-__ Ca acit _0_:�C1D_. Di s o al Field: Distance from nearest well/t,�QDistance from foundation...` Distance to nearest lot,l/i�ef__t _____.__ \` Number of lines 1 Length of each lin _ '; �_._! �' Width of trench - `--------- T Type of filter materiah�-_/___ Depth of filter material--_-- ------------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----------------- from foundation--------------------Lining material-----------__--___________________. ❑ Size: Diameter--------------------------------------Depth------------------------------------ -------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building__--__-_-_----_--__---_-_____-_.-----_---- ❑ Distance to nearest lot line.------------------------------ ------------------------------•------ ------------•--------------------------------------- --------------- `� Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------- -------------------------------•------------------------ -------------------------------------------------------------•------------•------------------------------•-------------------•--------- ------------------------------- ---------------------------------------------------- ----- ----------------------------------------------------------- ------------------------------------------------ ----------------------------------------------- ------------- I ------- - -- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, laws, an ,rules anadre ulatio df the Joaquin Local Health District. (Signed)__--_-. _____�---- /_-.�--_ __' _-_-------------(Owner and/or Contractor) BY:------------------------------------------------- �--------------------------------------------------------------------------(Title)-------------------------------------------- - ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------------- ----------------------- ---- DATE_-------------------- ------------------ REVIEWED BY------------------------------------ -..... DATE------ - ----------------------------------------------------- � DATEl� -� --------------- BUILDING PERMIT ISSUED-------------------------------------------------------------- ------ -------------------------------- Alterations and/or recommendations---------------------------------------- --------------------------------------------------------------------------------------------- ----------------------- ----------------------------------------------- -•------------------------------------------- ---------- ---------- ----------------------------------------------------------------------------••-------------- - ----- FINAL INSPECTION BY---- ------- -- l� �" 7 Date------ - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.