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iFOR OFFICE USE: ---------- - ---- ----------------- ---------- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ......711 _.._ (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 th herein cfes rt ed. This:application is made in compliance with County Ordinance No. 549. `- JOB ADDRESS AND LOCATIONIUP--_l� �`/�r -- •--.0 rI -- �'---��r�- ZOIX --- SA _ - -- ------------- �_ Owner's Name 110 ------ Phone------------------------------------ Address........ -----------------------------••----Address__..-... ' ---;M/1r-- ------------ -- -----------------------------------------------------------------------•-----•-•-••---------------------•----------- Contractor's Name---------_art _ ( --� ------ Phone................................... Installation will serve: Residence Vr-Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: - __ Number of bedrooms__ Number of baths ___ Lot size Water Supply: Public system ❑ Community system ❑ Private Z?<epth to Water Table ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sandy Loam El Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Ilf yes,date... ................1 No P11*" New Construction: Yes i2r'—No ❑ FHA/VA: Yest?�No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , Septic Ta Distance from nearest ll��r1___-__Distance from Toupdation-4407 -.- ....Material._ _ 'r-ee- >�� X No. of compartments - --------------_--Size .__ __ _ _ uid depth---- _ ---------------Capaci#y �. .__ Disposal Field: Distance from neares well- .....Distance from founda 'on___ �________.Distance to net lot Number of lines-_ _____�____ _-__..__Length of each line-ee-"._ _.__-..Width of trench � --- --- - ------------------------- Type of filter material �� Depth of filter materia -- length_- Q_�_________________._ Seepage Pit: Distance to nearest well-------- -----------Distance from; fouridation------------------- Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material--------- --------.Size: Diameter.----------------------Depth--------------------------------- �• Cesspool: Distance from nearest well----------- Dista ce from foundation Lining material------------------------------------- ❑ Size: Diameter----------------------_-----------De th----------------------- - - _Uquid Capacity----------------------------gals. Privy: Distance from-nearest well------------------------------------------- Distance from nearest building-------.______________....___-.-._._-_:.. ❑ Distance-to nearest lot iine------ ------------------ --- ------- --------- �-_ --- - -------- - -------------------------------------- Remodeling and/or repairing (describe):----- {i� /!rG� -------------- - ---- ---- ----------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------- 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 a d regulations of the San Joaquin Local Health District. (Signed)---------------------------- -- - - - ----Vr - - -------------- ---- - --- ------------------------------( r Contractor) By:-------------------------------------------------------------------------- --------- -(Title) ---------- - (Plot plan, showing size of-lot, location of system in relatio wells, buildings, etc., can be pl ced on reverse side). FOR D ARTMENT USE ONLY APPLICATION ACCEPTED BY---•--------------------- Y'--------------------------------------------------------- -- --- DATE------------------------ ------------- REVIEWEDBY-----------------------------------• --------------------- -� ---"----------------------- = DATE---f BUILDING PERMIT ISSUED------------------------------------------------------------------------------------- .�----- DATE ----------------- Alterations and/or recommendations--- ------------ -----`.--....----------------------------------------------------------------•--------------------------------------------- - - -__._-------- ---------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------•---------------------•----------•---•-------•------------•-------------------------------------- ---------------------------------------- ------------------------------------------------------------------------------------------------------------------------------- --------------•-------------------------------------- --------- ---------------------------- ------- ------------------------------------------------------------------------------------------------- ------------------------------- --- --------------------------- ----------- -------- ----------------------------------------------- --------- .� ----------------- --- - ---------- --------------- ----------- ---"---------- -------------------------------- FINAL INSPECTION BY------------------------- -------------------------------- Date---------------l--y... --f'`-`l- ---- ---------------------------- I'-,,--S7AN-JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 911h Street Stockton,California Lodi,California Manteca,California Tracy,California r. F..C;0.