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FOR OFFICE USE: tkJ7 &-& U-7�__O_ ---------------------------- ----------- ------ APPLICATION FOR SANITATION PERMIT Permit No. . f1- -sz� (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 LOCATION �S-7 --q- . > _ ------------------------------------------------------------------------------------------ s Owner's Name--2��A--------�- - ------ a ---- Phone. LZA Contractor's Name �1 -------------------------------------------------- --- Phone. Installation will serve: Residence Et'--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.1_.___ Number of bedrooms Number of baths Lot size __.--�------ ---mL'��------------------------ Water Supply: Public system ❑ Community system ❑ Private p9-`6epth to Water Table --C-Oft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [D`lardpan ❑ Previous Application Made: (If yes,date_,..... -__.-------) No 2111- New Construction: Yes ❑ No 2�' FHA/VA: Yes ❑ No'[�} TYPE OF INSTALLATION AND SPECIFICATIONS: (No leptic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: f Distance from nearest well-----------------Distance from foundation...................Material------------------------------------------------- y No. of compartments-- ----------------- -----Size--------------------------------Liquid depth--------------------------Capacity---------- --- -------- Disposal S)r: Distance from nearest we€I tO._____.._Distance from foundafi n__Z4'____'r____..Distance to nearest lot line --: ��11{{ T Number of filternmaterial_�o_f 1C__--__Depthhofff filter material------ '_._ .__.=Total length trench3 ______:--- __�__---- YP / -, Seepa e. Pit: Distance oto nearest wellf ___ __________Distance from fooundation__Z -------------- ---------------Distance to nearest lot Gne_ ____._____ rNumber of pits---- ---------------Number Depth--------- l 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):----- --------------------------- ------------------••-•----------------------------------------------------------------------------------------------- -------------------------------------- -----------•--------------- ------------------- --- ------ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 1 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 ales and regulations of t San Joaquin Local Health District. (Signed)---------------------- -- I --------------- --------------(Owner and/or Contractor) i 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----------------- APPLICATIONACCEPTED BY --------------------------------- DATE / �/ --- ------- / - ---------------- ---------- REVIEWEDBY----- -- - - ----------------- DATE---•-------------------•----------------------------------- BUILDINGPERMIT ISSUED-- ------------- ------------------------------ -------------------4iz---------- ---------------V- DATE----------------------,------------- ---------------------- Alterations and/or recomrgendations:__ ---.... _�_._ ��--------------- ------- ---------�_ / - ----------------I----- ------------------------ FINAL INSPECTION BY:.. _~-------- ------------------ 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 t F.P.CO.