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FOR OFFICE.USE: "m -------- -- ------------------------- ------------- kAPPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------------------ (Complete in Duplicate) Date Issued _______________ ____ ___tm__::...__ ---- This Permit Expires 1 Year From Date Issued ► 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. r .___!��.y-------- T:---- -------------------------- --------------- , JOB ADDRESS AND LOCATION. '�`�' Owner's Name____----/� -x=��.................. _____�I � �-` --- ------ Phone------------- --------------- Address------------_ ` ��_'^ Contractor's Name------�/�• �. � Phone l �`" `fir I � II Installation will serve: Residence ,Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _L_-__ Number of bedrooms J_____ Number of baths __2____ Lot.size .------f_ y...... 3'---------_______________ F Water Supply: Public system ❑ Community system 3—Private ❑ Depth to Water Table _2. 0, ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adore❑ Hardpan ❑ Previous Application Made: Ilf yes,date----------- No O New Construction: Yes ❑ No [A—FHA/VA- Yes ❑ No Eng" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank-or cesspoohpermitted-if-public-sewer-is-available within-200 feet.)- Septic ank: Distance from nearest well-----------------Distance from foundation--------------------Maferial---------------- _ ------ --------- No. of compartments------------ -------------Size--------------------------------Liquid depth---------- ---------------Capacity- ------- -------- I i II . r Disposa"I Field: Distance from nearest well.--!_U........Distance from foundation__/_�_--___..___.Distance to nearest lot line_�1_____.._____ 0� Number of lines-__:__.___/_______________._____Length of each line_____.`l _______,_____.Width of french_____ ._�_�_ Type of filter material____ri__e_c A-------Depth of filter material----.-f_e__ `___..Total length----------- --------------------- 1 __________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line._.__._._____-.-. \1 ❑ Number of pits---------_-----------Lining material---------------------- Size: Diameter------------------.----Depth--------- --I -Distance from foundation-------------____.Lining material--._---_-----------------------.__.__. Cesspool. Siizea Diameter neirest well--I_..------ - Depth--------------------------------- - ----------------Liquid Capacity------------ I1-------------gals. Privy: Distance from nearest well.... --------------------------------------------Distance from nearest building........__.____.._-�_________---_- _ ❑ Distance to nearest lot line-------- ------------------------------------ ------------------------------------------------------------------------- ------- -------- Remodeling and/or repairing [describe: ------------ - = -------------------------------•------•-----------------------k----------------- ---- �----�--- ----------- �= --------------- -------------- ----- ------------------------------------- - --------------------------------------------------------------------------------------------------------------------------------`- -------- ------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------L-------------------- I hereby certify that 1 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. f ! ` x (Signed)-- ------------------- ------ ..r Owner and or Contractor) -- ` --------------- ----- -------------- -- --(TitEe} -_;_ ---- (Plot plan, showing size of lot, locafion of system in relation to wells_buildings,etc., can be placed anon reverse slide). """"�"" FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------�[R...-O-------------------------------------------------- ---- --- -------- DATE---------- •---~-5 --'.� --- --------------------- REVIEWED -- ---------------- REVIEWED BY - --------------------------------------------------------- DATE------------------------------------- --------------------- BUILDING PERMIT ISSUED----------------i--------------------- ------------- ��-------------------- - --------------------------------- - ------ - -- - DATE----------------------------------------. Alterations and/or recommendations:,._--cov.fi.; _e>--_-_W_M.Ke.----- -------0-r_K_,.____W-_ Ti.k-0_- ------- -- - - ---------PRODJwD-------A-5-----614°tun/`------------------------------------------------ 1 ----------- -- --------- ----------------------- ---------------- --- -------------------------- ------ ------------------------------- --------- ------ - -- ------- ----- - ------ ---- -- --------------------------------------- ----------- ----------------- -------- FINAL INSPECTIO Date- /77 ---------- ----- _ __ _ SAN JOAQUIN LOCAL HEALTH DISTRICT ` 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 1 205 West 9th Street Stockton,California f Lodi,California` Manteca,California Tracy,California