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FOR OFFICE USE: ------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. IP-794-EZ ----------- ------------------------------------------ (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 nd install the work T�eein described. This application is made .in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---- -_ i-- ----- flt? ----Jei ---_------- - Tl ---- ✓--- [�_� 5 � ?__1 Owner's Name `�y �C�----------- ----------------------------------- it-�T -P _, -.__ - Phone.---•----------------- 74' Address--------,�L_ --- fr 42 --------- _ ----------------•-------------------•-•------....-------------------------------- Contractor's Name--- ----- -� 0 ---• - .�.-,07Z ------ Phone------------------- Installation will serve: Residence ©" partment House ❑ Commercial p Trailer Court ❑ Motel ❑ Other ❑ Number of living units:-,__- Number of bedrooms-_ Number of baths _/--- Lot size —---"------------------------ Water. _________________ _Water. Supply: Public system ❑ Community system ❑ Private �epth to Water Table � - ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0-"bay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,dote____---............} No New Construction: Yes �\Jo ❑ FHA/VA: Yes Z�- ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Q (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta4: Distance from nearest well__-1.0;FDistance r m foundation--- _____.--.Material ._ acit- ..No. of compartments__-.�.---.___...._-size _-� __---Liquid depth____ ��--------Ca p y !a- Disposal Field: Distance from nearest ell ......Distance from foundation-/-V............Distance to nearest lot line_ Er- Number of lines-------------i Length of each line----lop .-- Width of trench.- ---`--------------------- j Type of filter material --_ ___:Depth of.filter mate ria length length_---_, �_.________ - Seepage Pit: Distance to nearest well...-_P99_-_.---Distance fr m fogiclation---ZZ•_`" ist nce to nearest lot li o- ---- L Number of pits----- ------------Lining matenal__ _.$ize: Diameter_ .- -_ ---De th Cesspool: Distance from'nearest well-----------------Distance from foundation-----.I,._-.--------.Lining material----------------.................. ._- �..❑.. =,Size: Diameter- - ---- - - -- -Depths-- = ---- Li urd Capacity-. —. , , , meq.:- . .ap_ _ --------------------------_...� galls. . �I Privy: Distance from nearest well____._____._- --.....Distance from nearest building_--------------------- --------------------------- ❑ Distance to nearest lot line--- -- -------------------------- ------ ---------------------------------- ' Remodeling and/or repairing (describe): �� ------------ ` ---------•-------------------------------------- I€ a ------ --------------- ------------------------------ --------•---------------------------------•--------------•--------------------------------••------------------------------------------------------------------ ------------------------------------ ------------•--- ` ---------------------------------------------------------------- I hereby certify that I have prepared this application and thef the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regul tions of the San J aquin Local Health District. (Signed) ---------- --- �`� { r Contractor) f BY: - ------------ --------------- --- -- - (Title)�1 �1 I (Plot plan, showing size of lot, location of system i r anon to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------- - -------------------- --------- --------------------------------- DATE ------------------------------------- REVIEWED BY-------------- --- -------------------- ------------------------- ---------------------------------------------------------- DATA=------ ----------------------------------------------------- ----------- BUILDINGPERMIT ISSUED----------------- ----------------------------------------------------------------------------------- DATE------- --------------------- ------------ Alterations and/or recommendations-- ------------------------------------.------------------------------------.- -- ------------------- -•---•--------------------•----------- ------------------------------------ - --------------- ------- -------------- - ---------- -- -- - ----------------••---- - -------------------------- ...--------------------------------------- -------------------- ---------- FINAL INSPECTION BY:.----.. --- -------- Date------------ - - ----------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.ka:elton Ave. 300 West Oak Street 724 Sycamore Street 205 West 9th Street r Stockton,California Lodi,California Manteca;California Tracy,California F.P.C o. l