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FOR OFFICE USE: ------------------- _ . ----------------------- - __._.--.. APPLICATION FOR SANITATION PERMIT Permit No. .............�..� ----------_----------------------------- ---------------- (Complete in Duplicate) Q...� AETJslnityEx ires-.1-Year•From.Date,l/A&_&_ssuie� Date Issued Application is hereby made to the San.Joagdin Local'Health"DistFict'fora permit to construct and install the work herein described. This application is made in cam fiance, with o rd. a ce N 549. "f` g. pp I `a?b /0 // ,`1y/e' er ire -yam JOB ADDRESS AND L ATION h_O_lJ_I_`� ---- •-I`ve ~ RK I f1AC . Owner's Name------ --- IA Phone.- = Address----------------- - ---------1_0_19_1--........ ± .........-- Contractor's Name--------e),_V3c x "' -------------------------------- ------------------------------I-- -O--�'------------------------- Phone-•--------------•---._.....-------- p E] F] Trailer Court F-1Motel ❑ Other ❑ ' Installation will serve: Residence A artmen+ House y7 Commercial Number of living units: __�.____ Number of bedrooms - Number- ofbaths>----.__ Lot size4�_O-_____________________ Water Supply: Public system ❑ Community system ❑ ;P_rivateDepth fo, �/1�ater Table _ _ ft. Character of soil to a depth of 3 feet: Sand ravel ❑i Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-..............____) No New Construction: Yes Flo ❑ FHA/VA: Yes 0J_ No ❑ f � y TYPE OF INSTALLATION AND'SPECIFICATIONS: - -��(Norsels+ic-tank,or:cesspool permiked if public-sewer is=available-within_200_feet.] - f f _ { Septic Tank: Distance from nearest well __Distance from foundation.lt _______.Material_. .. __. No. of compartments------- - de,yp th----_-- Capacity---- ------------ -- Disposal Field: Distance from nearest we50_-__Dstance from --------Distance to nearest lot line.-,_5__ ❑/ Number of lines--------- Length,of each line----- ilk Width of trench----__- {,. Type of filter material_ _ _D_f=. -__Depth oftfilter mater-ill-1-6__....___..Total length__________ � __- r Seepage Pit: Distance to nearest well----------------------Distance from foundatio--__-__________--.Distance to nearest lot line-______.______.__ ❑ Number of pi s0_.7_____________Lining material----------- .........Size: Di'ameter----------------------- p J Cesspool: Distance from nearest well-----------------Distance'from-foandation _--Uning material------...._._.._______________--_---_ El A iSize: Diameter-------------_._ ----.-__-.-..--.-_._De th .._---_._..__.____ tLi uid Ca acitgals. ..m� Privy: Distance from nearest well___________________________ -------------------- - Distance from n1arest building---------_-------------._____..____-..... ❑ DistanclMo nearest ]of line.,,. --------------------- ------ I-- Remodeling and/or repairin (describe):es �____._---------------- - �c- r� - � _r .. 1 -" n �ti--r `� �r�� ------ - ---- ------------------------------- --------------------------------------------------------------------- -------------------------- ---------;-=-------------- - ------- ----- I hereby certify that I1have 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 Districts - (Signed)----- --- -- - ------------- - --------------------------------------------------------------------------------- -------(Owner and/or Contractor) -•-- rt ---- -- ------------ - (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 i APPLICATION ACCEPTED BY...... - '-- ----- -- ------ ------- --------------------------------- ------ DATE---- ---- --------------- ' REVIEWED BY------------------------------------ ------- ----- ------------------------- ------ --------- ----------------------------- DATE------------------------------- ---•------------------- BUILDING.PERMIT..ISSUED--------------------------------------------------- -------•- .---_ -- ------ --.DATE--------------------v---------------------------------------- Alterations'and/or recommendations:----.,....�._ --------------- ------------------------------------- ---------------------- ------------------------ --------------------------------------------------------------------------------------_...----------------•-----------........_ FINAL INSP Date------- -- f SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California I.acli,California Manteca,California Tracy,California F.P.CO. ,�