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FOR OFFICE USE: r09-3�--------- -�= /6 / ------------------- ------------------------------------ r�. APPLICATION FOR SANITATION PERMIT Permit No. ................ ... (Complete in Duplicated � Date Issued _-____.._-___`Y--J. ---------------------------I--------- 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 descried. This application is made in compliance with County Ordinance No. 549 JOB ADDRESS AND OCATIO # ---��--'r z / - __.L// , -------------------------------------------------------------------------------------------- Owners Name / -- ------- ---------------- ------------- Phone------------------------------------ Address------.y4e------ �� !/` �� -- ---------------------------------------------------------__---------------------------------- Contractor's Name--------- ---------------------------------------------------------------------•--- Phone---------_-------••------------- Installation will serve: Residence RApartment House [-]I Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I Number of bedrooms __/`�,Number of baths __/--- Lot size _f�_ ----------------------------------- i Water Supply: Public system ❑ Community system+[] Private �epth to Water Table6l ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date----------- ------I No New Construction: Yes E] No FHA/VA: Yes ❑ No t TYPE OF INSTALLATION AND SPECIFICATIONS: �; , �- • . r;i l (No septic tank or cesspool'permitted if public sewer is availabl' ,within-200 feet.) I p /� Distance of com aI nearest well_____----____._ Distance from founds - rs 5 Septic Yank: Distance from 'tion------------•.-----.Material------------------------------------------------- A ��r . p rtments-- --- -------------------Size--=_�------------------- --Liquid depth---- ---------------------Capacity----------------------- Disposal Field: Distance from nearest well-_. ----__Distance from foundatign__ --t------.......Distance to nearest lot ,�r f Number of lines________ ___ ____ ,.__ ength\of each line/f .e_ _ -- Width of trench-- ------------------------------ T e of filter material. _/l Jai _ _De th of filter materia__ ___ � Total length. y _____.Dista e to nearest lot line-e. Seepage Pit: Distance to nearest well___ .._�(,�--'___D'sstance fr. fo ation__�_� i � � �.�,�1---- Number of pits...._Z:---- g - Size: Diameter-' De to R - p Cesspool: Distance from nearest well._Li/--._---D material!Distance from foundation---------------------Lining material__.__.___.._------______.______.__---. Size: Diameter----- - -----------------f ----------Depth-----------------------------------------------------Liquid Capacity-.--------------------------gals. Priv Distance from nearest well;:._! t ❑ - p,.'y Privy: r _. � ;�:�.:gC}istance from nearest building f ElDistance to nearest lot line:... -- --------- ------ -------------------------------------------------------- ----------------- -------------------- Remodeling and/or repairing (describe):---- ----� �c ---- --'-��- ---------:-=------ - -- -------------------------- I ---------------I--------------------------------------------------------------------------------------------------------------------------------- I ------------------------------------- -----------------I-------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. l Contractor (Signed) •� [� ------- ---------- fTitle_ . _-- :_ j[Plot plan, showing size of lot, location of sys in relation to wells, buildings, etc., can be placed on reverse side]. r f _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- ------------------------ ---------------------- ---------------------------------------- DATE--------- 3 6 REVIEWEDBY----------------------------------- - - -------------------------- --------------------------------------------------------- DATE------------------------- ---------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------ ----------------------------------------------------- Alterationsand/or recommendations:------ -- -------------------------- --•------ -----------------------•--------------------------------•----------•----------------------- ------------------- --------------------------------------------------------------------- --------------------------------- -----------•-•--------------------------------------•--------------------------------------------------------------- 1 1 ---------------- ------------------------------ -------------------------- ---------•-----------I-------------------------------------- ----------- -- ------------------- --- ----------------------- ------------- ----------------- FINAL INSPECTION BY: - Y... /- ------------- Date-------`3� ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California t ' ; Manteca,California+ Tracy,California r.P.00.