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FOR OFFICE USE: ----------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...._____..___.--___..._ (Complete in )uplicate) This Permit Expires 1 Year From Date Issued 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. JOB ADDRESS AND LOCATION t -'.. � ��t/--------------------------------------------------------------------- Owner's Name------------ /¢G-v. ?../ _S f 1> -- - 5-_-----_- ---------------- Phone-A/ Address--------- + ,� -------- /`'_____. ___ ______________________________________________________________________________________ Contractor's Name------ �/•�--�'Z--..... ..,,h1r.� r / C-.- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑� o el ❑ Other ❑ Number of living units: _1j._ Number of bedrooms __ _ Number of baths ___/_ Lot size _.. __________-.-_-__ Water Supply: Public system El Community system ❑ Private Depth to Water Table s ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 8& Clay ❑ Adobe ❑ Hardpan ❑ ! _-. New Construction: Yes ❑ �. Previous Application Made: (If yes,date_________________ )- No � ❑ No �. FHA/VA: Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tank: Distance from nearest well-----------------Distance from foundation__ ----------------Materlai------------------------------------------------- [] g xX13r//1i4 No. of compartments------ -----------------size------------------------ ------Liquid depth---------------------- P ___Capacity -y------------------- -- � Disposal I al Field- Distance from nearest well,_�V_/_._Distance from foundation__�49-----------Distance to nearest lot line_____.... Number of lines---------- Length of each line___��'�__7_____----------Width of trench_..___�_�__��___..____ --- -------- Type of filter-material Depth Depth Afilter material___/ _____.To#al-length-------.1•"J_ -------------------- Seepage Pit: Distance to nearest well_______ ___________Distance from foundation----.---------------Distance to nearest lot line__.__.____.._____ ❑ Number of pits----------------------Lining material-------:._.............Size: Diameter.----------------------Depth.......-------------------.------ 4 " g TT Cesspool: Distance from nearest well______..___.-._-Distance from foundation.-___.7_ _.__ ._.:..,Lin.in� material_____________________________________ ❑ IF Size: Diameter-------------------------------------Depth----------------------------- - ------------------Liquid Capacity----------------------------gals. ' Privy- Distance from nearest well-------------------------------------------------Distance from nearest building.___...._____._____.__________._._____._. ❑ Distance to nearest lot line F - ------------------ -----------(-------------------------------.------------------------=------------------_---- 1 Remodelingand or repairing descry e',)_ -_-_ _ �Tt . � k� ` --- r ---------------------------------------------- -- __..------------------------------------ ------------------------------------Ihereby certify thatil have prepared this ap -�.--------------------------------------------------------�-' cation and that the work done`�in.accordance with San Joaquin County ordinances, State laws,'and rules 'and r tions of theSan-J•o�n o l �alth District. r--- (Signed)---------�-e-- -- ------ •� i�G f - r - - =��. _Owner#end/or Contractor) By - (Title) ~ --- - (Plot plan, showing size of�lot, location ystem in relation..to wells,-buildings etc., can be placed on reverse side). ,�" r FOR DEPARTMENT USE ONLY II APPLICATION ACCEPTED BY ____.__._ �� __!______- DATE-___°_._ �O ----------------------------------------------------------------------- ----- - REVIEWEDBY_ 4-----------w' -•'----- .,------ ----- ---------- DATE ------. -------------------- --------------------- BUILDING PERMIT ISSUED- �".';�:.,,---- �� '�"„t_..= - _ ------------------- DAT = 3 - Alterations and/or recommendations:-----_ �`S.!t __-• ,qui-----I_� ----:-�'�:4---j ,_---r ---- ------c_- 1-1� ------- , ..- -----`----- `� --------- t -�`Al!--------- '------------- ------------ - _ � -- --- --------------------._...---------- \ 1 ) t 1 + ------------------------------------------------------------------------------------ --------------------------------------------------------------------- ----- ---------------------------------------- I ----------------------------------------- -------------- ------------------- ------------ ----------------------------------------------- ------- -------- --- -- -------- - ------ -- -- --------- ------ J FINAL INSPECTION BY: . Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Mantecar California Tracy,California F.P.0 C. 4 e...