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rUKUrrl(-.k USt: ------------------------ -------------- ---------- ------ APPLICATION FOR SANITATION PERMIT Permit No. __ ------------------------------------ ------- ---- (Complete in Duplicate) ` , ------------- --'----------------- --- This Permit Ex ices 1 Year From Date Issued Date Issued _�� Application is hereby made to the San Joaquin Local Health District for a permit to constructand ins the work herein described. This application is t made in compliance with County Ordinance No. 549. Ota f 00_32-- X27?yiE. E o . JOB ADDR—ESS ANR OCATION-�OIA,_,-�-e4, ...Y_--,- ' ,�, i Owner's Name----_ '. - ----------------- ------------ Phone._-------•- ------------- ------------ -- --- -----------Address , :.'= ------------------------------••--------•"----•--- Contractor's Name------- Phone- �-•- - -- ---- --- ------------ Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court E] Motel [-IOther ❑ 1 i Number of living units: ---f." Number of bedrooms _yNumber of baths Z---- Lot size " -i-r-e --------------------------- Water Supply: Public system ❑ Community system [j Private [!rDepth to Wafer Table -------- ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam El" Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {lfyes,date-----------...------I No ❑ New Construction. Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is bailable within 200 feet.) Septic Tank: Distance from nearest well--------------- Distance from foundation-------------------Material_ El No. of compartments---- ------- ----------Size=-------------- ---- -------Liquid depth--------------- ----- ----Capacity Disposa Field: Distance from nearest well___tSo _Distance from foundation----_Z_o._."-...Distance to nearest lot line"--S___'___- Number it lines------------/--------------------tLength of each line------�_o c5_- -----.--Width of french--------- ---------------- N Type of filter material_---"s-1Z--""-7-pep#h of"filter material:_/4'- ...-___Total length_-_/AA ---------------------------- Seepage ..__-"" as#once ,from foundation--------------------Distance to nearest lot line_---..-_-_---- ❑ Pit: N�umaberof pisto fest well----___L'dning material__-" --.-_-_ ' ' ------ ..Size' Diameter-----------------------Depth-----------------•------------ ;m Cesspool: Distance from nearest well _.-1-____"-- Distance ram foundation___-_-.-____-----.Lining material_.-__ ---------------------- -------- ""." _ ---- - ❑ Size: Diameter. - -------- Depth_--If -- ------ -- I--------------------liquid Capacity gals�� Privy: Distance from nearest well_____ _ ------------------------ """ I l ------._Distance from nearest building-------------------"________--- P ❑ Distance to nearest lot line- --I------------------------- -------------.---------- # """ ----------------------------------------------------------- ( - 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, State laws, and rules and:(regulations of the San Joaquin Local Health District. _ (Signed) - . ---- ------ ------------- ---- -------- - ------------------ rContractor) -�-� nd/o B - --r . r -- -- - - �`" _" --------(Title).. -- - - ' (Plot plan, showing size of lot, location of sys+em`in relation to w`ells�buildings etc:,can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED --------------------------------------------------------------- ----------- DATE----_-- VIEWEDBY---- --------------------------------- ' ----------------------------------- DATE - -- -------- - --- -------- ------------- - --------- -------- --------"-------------------------------- �---- BUILDING PERMIT ISSUED- DATE Alterations and/or recommendations:."."" ---------------- ----------------------------------------- e FINAL INSPECTION BY--- --- ----------� -------------- Date----.?_.--------- ,-�� ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1607 E.Harelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9!h Street Stockton,California Lodi,California Manteca,California Tracy,California