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FOR OFFICE USE ------ - ---- Permit No. _. - APPLICATION FOR SANITATION PERMIT --'-'------------�-- _________________________________________________________ r . - -- --- -- -=------ --- {Complete in Duplicate)'' Date issued �_� ' su ! �� 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 des le�� This application is made in compliant wiit,�h�County Ordi�na/nce No. 549. JOB ADDRESS AND LOCATIO 5--.--4`V-----R_j_PO_--------�D--- ----- � { Owner's Name—------------CIQ - ------- Phone__..�'�__9�_�&f--4p- I --- - - �_�--------- -- ' 'a....._, � .9------------------ 1--pe-14---- ------------------------------ Address - 'I -- --------••----------------- sa�_/7 ------ Phone--------------------- ------ Contractor's Name------------------------- ---- -------------•----- --- --------------------------------- Installation will serve: Residence B Apartment House ❑ Commercial ❑ Trailer Court ❑ Mo#el ❑ Other ❑ - Number of baths __-t.._ Lot size ____1Q x____/Z --------- -_ Number of living units: ___.____ Number of bedrooms _� -------- Water Supply: Public system ❑ Community sys# m El Private �epth to Water Table -------- 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.. .................) No [ New 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.) �Pr-G14,rT�a kMaterial_ j.y �-- 't~ Septic nk: Distance from nearest well...... Disfiancp from forndatio�s-____�a-_--- -. ------------ ------------------------ 04 t No. of compartments------------ depth-------- --___-.-Capacity-- v�-. ----- f Q g4 )stance to nearest lot lin _ - ___-____ Dispos Field: Distance from nearest well---11__-_____.Distance from foundation___ -____l____ . Number of lines------- � ------------_ ength of each line_ _ ---j "��f�Vidth of trench------+' �--------------------- Type of filter material____-j_ __�QG epth of filter material____._-�_f________Total length_______M-�:____------------------- I Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__._--____.____._ ❑ dumber of pits----------- ----------Lining material----------------------Size: Diameter---------- ------------Depth--------- ----------------------- Cesspool: Distance from nearest well________________Distance from foundation---.--------------- Lining material-__.____...___---- __.__. __._; ❑ Size: Diameter-------------------------------- ----Depth-------------------------------- - ----------------Liquid Capacity----------------------- gals. _____________.___-------------------------Distance from nearest building._..________.__----_..___----------------. Privy: Distance from nearest wel!______ Distance to nearest lot line------------------------- ------------=:'"- -------------- .....-- Remodeling and/or repairing (describe)--------------------- ------ ------------------------------------------ ------------- ------------------------- f --------------------------------------------------------------- --- =---------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ ---- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 1 ordinances, State laws, and rules and regulations the San Joaquin Local Health District. (Signed -_ ------------------------(Owner and/or Contractor) ---' -=---------- -------- ----------------W-(� �,------ --- = (Title) y:.---=------------ •- - - ------------------------ (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 APPLICATION ACCEPTED BY--- ..T --------------- --------------------- ------------------------------ DATE......�. aJ.- T ��----------------- REVIEWEDBY----------------------------------- ---------:------- DATE-- --------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------ --------------- - --------- DATE----------------------------------------------------------- Alterations and/or recommendations:------------------- -------- ------------------------------------------------------------------------------------------ r -----------------------------------•--------------------------------------------------------------•--- ----- ------------------------ ------------------------------- - ----------------------•--- --------------------------------------------- ---- -------------------------------------- -------------------I-------------------------------- - --- Qate. - a, = FINAL INSPECTION BY:. -- - ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street. Stockton,California Lodi, California Manteca,California Tracy,California F.P-CG.