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FOR OFFICE USE: �� l ------ -- ------ --------- ---------------------- - - APPLICATION 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. JX4-rGF1 JOB ADDRESS A -- -@a eye E� ----•-- _Y_000 : # :=_t ----------------- LOCATIONC __& 1-�� f • " j Owner's Name. � C� ` j ` f ---------- ----------- Phone-------------------- - Address-_-� jNd:_e ....Av_<.------ -2 _ 'i -----------------------_----------------------------------------------------------- ---------------- Contractor's Name---- f-'i---- t�--.d •-- Phone----------------------------------- + Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _I--- Number of bedrooms _ __ Number of baths ___lt__: Lot size __�_I��/�� =-- _____________________ � Water Supply: Public system ❑ Community system ❑ Private [Y' Depth to Water Table -1.0 ft. Character of soil to a depth of 3 feet: Sand g Gravel ❑ Sa dy Loam ❑ Clay Loam El Clay [I Adobe [—IHardpanF-]_ _ Previous Application Made: (If yes,date...._____ , _...__) Noe New Construction: Yes ®{" , ❑ 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---- ---Distance from foundation_____--j 0_.__.Material-__.075;�_�_Y_ 6 ------------ No. of compartments_._._...____-_ - - --- Size--- d -- epth----- - /Z- — Capacity--/Disposal Field: Distance from nearest well...... Distance from foundation____' ----------.Distance to nearest lot line_------_____--- �' Number of iines__.__________� ._____ Length of each line______J8___� T //�� --------.Width of trench-------- .- •-- Ir Type of filter material___ f�1 ,.._._Depth of filter materiaL._.___r_ ._...._.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------------------------- De th------------------------------.-------- ------------Liquid Capacity -- 9als Privy: Distance from nearest well___________ _____________________________________Distance from nearest building------------------------------..------ -- ❑ Distance to nearest lot line--------------------------------- -------------------------------------------- ---------------------------------------------------------- -- Remodeling and/or repairing (describe)---------------------------------- -------------------------------------------------------------------------------------------------------------------A ----------------------------------------------------------------------------------------------------------------------------------------------------•--------------------------------- ------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, St e Ifs, and rules and regulat'ons of the San Joaquin Local Health District. __. Owner and/or Contractor)------ --------------------- By ------------------- 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--- s �� ` ---------------------------- ---------------------------------------- DATE------ �`� ...... BY-------------------------------- ---- --------------- -------------------- -------------------------------------- DATE-- --------- -- ------------- BUILDINGPERMIT ISSUED--------------------------------------- ---- --------------------------------------------------------- DATE------------------------------------------ --------------- -- Alterationsand/or recommendations---------------- ------ ----------------------------------------------------------------------- -------•-------------------------------------------------------- ---------------------------------- ---------------------------------------------------------------- - --------------------------------------- - ---------------------- ------------------------------------------------------ --------------- ---------------- ------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECT �B-Yr. ilr/ 1 Date--- 4�2_...._....�-��---------------------------- I� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazetion Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.= /