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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ...................':__ ----------------------- - - -------------------------- (Complete in Duplicate) ---_-----------------------_----_.__.___..__.__... - This Permit Expires 1 Year From Date Issued 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 LOCATI N-%, 410V - ----- -----------* .......... Owner's Name--------0t----- ------------------------------------------------------------------ Phone Address = ' -------- 1� -- - - ----------------- ---- ------------------------- Contractor's Name--------------Cg�e?� ' Phone .._.._. Installation will serve: Residence M<Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ __ Number of bedrooms __ Number of baths _cam-" Lot size _____/_Q ----- ----------------------------- a Water Supply: Public system ❑ Community system ❑ Private ff___6epfh to Water Table /-,;7- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [T"Ciay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [l}�New Construction: Yes ❑ No [&"'FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: —(No septic tank or cesspool permitted if public sewer is available within 200 feet.) y " S ti *Riel Distance from nearest well------ Distance from foundation__________________ Material-_____.__.___._-.._____...__-_----------------. No. of compartments - - -------------------Size--------------------------------Liquid depth--------------------------Capacity----------------------- DisposDistance from nearest well--- o.___._Distance from foundation___ .__--_.Distance to nearest lot line--RIJ------ Length of each line__) "� f Number of lines- --- -------------p --U --------- -----.Width of trench_ v1__��------�----------"-• Type of filter materia#_5� Wd ""-Depth of filter material___/__t�---------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)-------------------'------------------ --=----------•-•-•----------------------------- ---------•------------------------------------------------------- --------------------------------------------------------------------------------------------------------------"------------------------------------------------------- - ----------------------------------------------------- ----------------------------------------- ------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St a laws, and rule and r gulations of the San Joaquin Local Health District. --------- -- --- - ----------------- - --- --- Ow er and/or Contractor (Signed)------- ---- ( ) -_ ,BY-----------_ = _ == _ --------------------------(Title) - ------- "(Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY T-f -` 19 sDATE � c ----- ----------------------------------------- REVIEWED BY--------------------------------------------- -------------------- ----------- ---------------------------------------------- DATE------------- -- ---------------------------------------- BUILDINGPERMIT ISSUED-------------- •---------------------------------------------------------------------------- --------- DATE--------------------------- --------------------------------- Alterationsand/or recommendations:-------------- --- --- ----------------- ------------•-------------------------------- --------------"------------------ ----------•--------------------------- ------------------------------------------------------------------------- -- - ----------------------------------------------------------------•--•----------------------------------------------------------------- ---------------- --------------------------------------/---•-- ---------------- - -----i---------------------------------------------------------------------------------------------------------------- ------------- ---- ------------------ --- ------------- -- ------------------ ------------------- --------------------- ------------- -------- FINAL INSPECTION—BY. !1'/✓A�/r `-872 .- Date.------------------ ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,.Colifornia Manteca,California Tracy,California F.P.CC.