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r-UK VI-W-t USE: — - ------------------------ ------- ---------- ----------- ----------- _ APPLICATION FOR SANITATION PERMIT Permit No. ..1.. .-� . ------------------ - ----------- ------------^--------- (Complete in Duplicate) '! -------- --- -------- ----------------- Issued --- From Date Issued Date Id =---- ��--- --- This Permit Expires 1 Year i 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 L CATION-_'_1""...._ ,�+ - ------------ -- ---'�` ew- .. -------------------------------------------------------- --- ---------- Owner's Name----- ""-- --------- Phone4__ r�------ Address. .. - ---- ------- --------------- ---------------•--------------------------------------•---•--------------------------- Cent racfor'5 Name----------- •r � � fr•�!" l 1 � ----------------- PhoneQ��-•---- Installation will serve: Residence !'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ --" r . Number of bedrooms .��.___. Number of baths .15--. Lot size --- Water Supply: Public system Community system ❑ Private ❑ Depth to Water TaHe 4.10 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy,Loam ❑ Clay Loam[��ay❑ Adobe ❑ Hardpan ❑ t Previous Application Made: (If yes,date----------------- No ew Construction: Yes No �� ❑ [ A/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 rfoundation-------------------Material-__...-__... ------- No. of compartments----------------------- --Size---------------------------------Liquid depth------------ ----------- Capacity----------------------- -4.4 Disposal Field: Distance from nearest well- ----Distance from foundation.-�,(�"-1----Distance to nearest lot line.__' I Number of lines.__"_"./"- ,y ------------- Length of each line----�d------------------Width of trench------a ------_-- . Type of filter material.-- of C!--Depth of filter material__4r_",__.. ■ dotal length --------------------- Seep Pit: Distance to nearest well---- "..__-.._.___...Distance fro foundation..-_. --` Distance to nearest lot line_.-s� '--" Number of pits-----f-.__f.___--"-_Linin material-- W r s 9 sl*�Size: Diameter._��. -----------Deph..,, °_ N Cesspool: Distance from nearest well.................Distance from foundation----------_---------Lining material---------------------- ------------- ❑ Size: Diameter----- ------------ ----------Depth------------------------------------ -------------- Liquid Capacity----------------------------gals. N Privy: Distance from nearest well-------------------------------------------------Distance from nearest building - ❑ Distance to nearest lot line ------------------- ------_-_ Remodeling and/or repairing (describe):..-...-_-. -------------------------------------------------------------- ---1----- -------- -- - ---- ------- ----- � .cls - - --------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---- ------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and s and regulations of the San Joaquin Local Health District. {Signed} ^----------------------------------- ------------ caner rrd/or Contractor) 1n d 1 By -----------------(Title} ------ ----Y ........... ------ --------- (Plot plan, showing size of lot, locatio f system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.---.._. __-_:_ - - ------------------------ DATE `" ... 1. REVIEWED BY DATE---- - ------------ --- --------------------------------------------------------- 13UILDING PERMIT ISSUED - ------------------ DATE Alterations and/or recommendations:----- ------------------------------ ---- _.....- ------------ ,,.'ft{may .........."-_"................................"..._..__•------•-_......----_---__......__-----------------. _.-..-..---.-.....---....-_.-...-..-._.....---....-----------......-----------.-..__-...._._-.-..------- �c� - _ -----�-: -- - ----- ----------------- --=�--- ------------- ----------- -- ------------------------------- ---------------------------- FINAL INSPECTION ------- Date-------- /.-- -- l.............r SAN OAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. j300 West Oak Street 724 Sycamore Street 205 West 9th Street Stockton, California Lodi,California Manteca,California Tracy,California