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FOR OFFICE USE: 2 ---------------- - ---- -----------------_--------------- --____-------------------_---------__-------------_ A PLICATION FOR SANITATION PERMIT Permit No. ........................ --------------------------------------------------------- (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 described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATQN--- ..1.7_ _ :5 —(- Owner's Name ` `------C- =......C 2 ----•----------•------•------ --•--. Phone----- ------•---.-.-- ---- G.. Address.----------_------ S'-G iommercial ----------•------------------------- --------------------------- --------- -_-_---------------------- 3 Contractor's Contractors Name- - -------4.er-_��_--�1!�� ------------------------------------------------------------ Phone----------------------------------- Installation will serve: Residen e 6 Apartment House ❑ ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --t---- Number of bedrooms ----Y_ Number of baths ----I... Lot size .. ____ --------------------- ________________.._ Water Supply: Public system E] Community system �rl Private E] Depth to Water Table 0Y-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----------------.-__) Noy] New Construction. Yes No ❑]FHA/VA: Yes [-] No s TYPE OF INSTALLATION AND SPECIFICATIONS: 71"f_4 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se ti Tank: Distance from nearest well./96p_�-Dista ` fro ounda*-----1 )-------MateI _ XNo. of compartments_ ____ _ __ C� apacity_1_ f%_<_____.___.. Disposal Field: Distance from neare well__/_�! _�'Dhstance from foundation... .U------.p��'st nc,e to nearest lot i Number of lines_._.__r Length of each line_fs:_� ." =:`Widtlf of trench � .______________ Type of filter material-J_._i__ L'_ _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-----------------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-----------------------------------------------------------------------•---------••------------- ------------------------------------------ Remodeling and/or repairing (describe):---------------------- ----------------------------------------------------------------- ----------------------- ---------_----------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- GO ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- 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. YZ (Signed)----------- -� z Com{/!• --------------------------------------(Owner and/or Contractor)-- ----=/�z_�< By:---------- --------------------------------------------------------------------------------------------------------------------- ---(Title)--------------- --------------- -------- (Plot ------(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----------------- ------------------------------------------ REVIEWEDBY----- ------------------------------ ------------- ------- ------- --------- DATE----h5-` 4----&;G----------------------- BUILDINGPERMIT ISSUED------------------ ----------------------------------------------------- ------------- ------------- DATE------------------------------------------------------------- Alterationsand/or recommendations------------------------------------------------------------------------------------ ----------•---•------------------------•-•-------------------------------- ------------------------------ ----------------------------------------------------- -----------------------------------------------------------------------•------------------------------------------------------- ---------- ---------------- ----------- ------.� t ----------------------------------------- ---------------- -------------------------------------------------------------------------------------- - ---------- ------- ----- - ----------------------- 1 FINAL INSPECTION BY:----- ----------� � Date A?_��` �f� 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.