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FOR OFFICE USE: ------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No.------------------------------------------------------- 1.._ ----------------------------------- -------------------- (Complete in Duplicate) Date Issued ---_______----_______---------------------_----------.___ 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. TGA JOB ADDRESS AND LOCATION-----IN_'----�'4 `------�-/ ----- � `' = '► `' �1{y. Owner's Name------- -- ------------ --------- ----------------- -------- ------------------------------------ ---.-. hone_.-Jt,r�--------------- AddressQ /.... .. ----- - - ------ --•-------------------------------------- Contractor's Name---- .X �`�-------- Phone.. �1� - ]lf ------------- -----------•-------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ Number of bedrooms _ __ Number o baths __l___ Lot size __-__1-._.__��_e_-_j_` --_____________-----______ Water Supply: Public system ❑ Community syst m ❑ Private Number to Water Table _37 ft. Character of soil to a depth of feet: nGravel Sand Loam Clay Loam Clay Adobe Hardpan C p 3 e Sand y ❑ y ❑ y ❑ ❑ p ❑ Previous Application Made: (If yes,date........___------ ) No eNew Construction: Yes ❑ No FHA/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 weil_�y_6_0------Distance from foundation---/D________.Material---- �� rPJ�'____ No. of compartments.......A--- --------- Liquid depth-----5 ---------Capacity--/,AA e?------ Disposal Field: Distance from nearest well._.S'Q------Distance from foundation-h_ ____________Distance to nearest lot line-_.5..._----- . Number of lines___ r _________________Length of each line_____,��_._._._________.Width of trench__-�`�-. _..______________ Type of filter material_�t t----__-----Depth of filter material___- ---------Total length------f!!_l__4r_________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------N ❑ Number of pits.--- Lining material---------- ------------Size: Diameter------------.----------Dept h------------------------.-------- Cesspool: Distance from nearest well---------_-------Distance from foundation.-------------------Lining material--------.._.__._____-______-_____.___ ❑ Size: Diameter- --- --------------- -----Depth----------------------------- -------------------- Liquid Capacity----------------------------galSN- Privy: Distance from nearest well------------------------------------------------_Distance from nearest building----------------------------------- ---_ ❑ Distance to nearest lot line - --- ---------------------- ---- - - ----- - ----------------------- ---------------------------------------------------------------------- Remodeling and/or repairing {describe `- u -----------.-'- i�' --------- -------------------------------------• ------•--------- _______�__---e_ __ - --------' ---------• — '�-------------------------------------------------------------------------------------------------•---------------------------- --------------------------------------- --------------- --------- f 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 +he San Joaquin Local Health District. tA (Signed(- -�-----•-- - ------- - --------- -- - - --c ----- ------------------------ --- ---------------------------------------------(Owner an /or Cont r cfor) e BY= ------ ---• --------- ------ --------- ----------------------------------------------- -----------Ftle]-=--- - ----^-- - --------- -- - ---- - ------- (Plot plan, showin ze of lot, to ation of system in relation to wells, buildings, etc., can be p1 on rever side). ` -� FOR DEPARTMENT USE ONLY n APPLICATION ACCEPTED BY-------+/-- - --r-R----��-- -------- --------- ------ ------ --------------------------------- DATE--------AP-7/.3_ 7------------------- I REVIEWEDBY----------------- --------- --- --------------------------- DATE------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------- ------------------------------------------ DATE--------------------------------------------------------- --- Alterations and/or recommendations:-------------------------- ------------------------------------------ -----------------------•-------------------------------------------------------------- FINAL INSPECT! ------ ------ -- ------------ Date_-.. -.--�Q_'� _.-`�� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodir California Manteca,California Tracy,California F.P.C C.