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FOR OFFICE USE: � _0_q(�, / �, (p I _ �1"'off 101-/ I ------------ ----- `I I 2f �_9 APPLICATION FOR SANITATION PERMIT Permit No. 1�-----.�...... --,---- - - --- -------- (Complete in Duplicate) r Date Issued _ --------------------------------------------------- - This Permit Ex fres'll 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 Ordi ante No. 549. JOB ADDRESS AND LOCATION--!!__ �1— --------a`-p" ------- -- -- ------------- - n ------------------------------------ Owner's Name .0 •-------------- Phone----•-------------------•-------•--- Address------------ Jv_.... d--------•----------------------------- - c-- --------•--------------- r ,s 1 Contractor's Name_ ---------------------------------------------- "'--- Phone----------------------------------- Installation will serve: Residence W]i Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---!_--- Number of bedrooms ___-3--- Number of baths _-I-___ Lot size _ ___.___ -_ Water Supply: Public system ❑ Community system ❑ Private [V Depth to Water Table _ rit. Character of soil to a depth of 3 feet: Sand [-] Gravel ❑ Sandy Loam] Clay Loam [jClay E] Adobe ❑ Hardpan ❑ i Previous Application Made: (If yes,date..-_.---------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �J Septic Tank: Distance from nearest well_li9b----_Distaice fro foundation_10.............Ma eriai_.__ ------ __-_. No. of compartments---xr__________--------Size_ ` - ---�.---Liquid depth------ ------------------Capacity_�c Disposal Field: Distance from nearest well-/.e O---.._Distance from foundation__�--.4---------Distance to nearest} lot line_.--------- © Number of lines----3___,�,_-r-p--�-----------------_.-_Length of each line._.A��.`-._---._._..... Width of trench.�^`?f_-#-------------------- Type of filter materiq& pelf---Depth of filter material----19- --_Total length_-_,A-Q 0_.`______________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---------------- Num.ber -.-_-_-__-__.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----------------------------- ------------- - ---------------------------------------------------------------------------------------------- Remodelingand/or repairing (describe):---------------------------------------------------------------------- ------------------------------------------------------------------------------- ---------------------- { l 1 ----------------------------------------------- ) ---- ------------------------------ --------------------------!----- ------------------ ----------------------------------------------------------------------------------------------------------- ------------- -----...- I hereby certify that 1 prepared this application and that the work will be done in accordance with San Joaquin County "ordinances, Sta ws rule an s of the San Joaquin Local Health District. d4 - --- --- ----- -------------------- ------ ------- - ------------------ ------------------------------------------=-- -------(Owner and/or Contractor) (Si }9ne t By: - -------------------------------------------- -----------------------------------------------------------------------------------(Title)----------------- ---- ----------------- ----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). a FOR DEPARTMENT USE ONLY f -t APPLICATION ACCEPTED BY - -- ---- --=------ --------- ---------------- DAT REVIEWEDBY-------------------------------------------- --------------- ------ DATE-------------------•---------------------------------------- kBUILDING PERMIT ISSUED------------------------------------------------------ ---------------------------------------------. DATE----- --------------------------- ------------------•------- E Alterations and/or recommendations---------------- -- -- ------------------- ----------------------------------------------------------------------------•------------------•------------------ 1 ______________________________________-----._...._...__._-_.-_-.____...-----__.._..._._----_---__.__---------____._--------_____---_--._.-__________._-___-.....____--___.._-___-_-____-._-_._-_-.-.-_._._________._--_ -----------------_-----------------------------------------------------------------_-----------------------------------------------------_----- ------------------------------________________________________________________________________________________________________________________________________________________________________________________________________ ------------_----------------------------------_-----_____________________________-------_--------------------- FINAL INSPECTION BY:-. _.._._. .. YYliLvj - Date--- az ..( ._ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasetton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy, California h F.RCO. I