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F OFFICE USE A �; c Permit No. -f•=`� ( `_ �_c ---- APPLICATION FOR SANITATION PERMIT -3 ------------------------------------ ---------- (Complete in Duplicate) y Date-Issued . 4L /�/, This Permit Expires 1 Year From Date Issued . r Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. i This application is made in compliance with County Ordinance No. 549. 3 --•-----------------------------•--------.------------------ JOB ADDRESS AND a • � ----------------- --- Phone--•----•-------------•-------------- Owner's Name_ T -e -------------------------- Address..------------------ -91400-6-....-- 5 / -•-•------•-----•------ -----------------•-•--- � 1 Contractor's Name------ --------15- ---- ------ �df/ems_--------- Phone_ -- Installation � will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ "Other ❑ Number of living units: j._-_ Number of bedrooms -*.2.e- Number of baths _ .-___ Lot size __________________-__ Water Supply: Public systemic Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand [❑ Gravel ❑ Sandy Loam ❑ Clay Loam E❑ Clay ❑ Adobex Hardpan ❑ Previous Application Made: (If yes,date--------- ----------) No56' New Construction: Yes ❑ No FHA/VA: Yes E] No� TYPE OF INSTALLATION AND SPECIFICATIONS: K (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------..-----.__--. ❑ No. of compartments----- --------------------Size--------------------------------Liquid depth-------------- --------- Capacity----------------------- Disposal FielcL Distance from nearest well-V%.&-1'ut,,Distance from foundation------V0 ........Distance to nearest lot line_____ __________ Number of lines---•__---- • -V._ --- Length of each line-------- as—_,- ---------Width' of trench-----------vim- +"------------- -- - .___-- Type of filter material--- Depth of filter material--------- -?'- ....... length________________________e31V________ �� Distance to nearest well --Distance from f ndation___._ ti Seepag Pit; '�.�______. Distance to nearest lot line_____ __...._... Number of pits---------I.------- ---Lining material-_�._-.- - �--Depth----------�-�--------------- G + Size: Diameter__._._' ` ` iJ Cesspool: Distance from nearest well----------_---_Distance from foundation--------------------Lining material__._______________------------___._.-. r ❑ Size: Diameter---- - ------------------------------Depth------ ---------------------------------------------Liquid Capacity- ------------------------gals. Privy: Distance from nearest well --------------------------------------------__Distance from nearest building__________._______.___________.,____ -- ❑ Distance to nearest lot line _-------------------------------------- ----- ------------------------------------------------------------------------------------------------ �- Remodeling and/or repairing (describe):--------.0 - ---- ----a_J�.=�LL,--- - ----- -r-&- - ------------------------------------------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------ - - ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r ordinances, State laws, andrules and regulations of the San Joaquin Local Health District. ] . y (Signed) --- ------------------------------------------ -----{Owner and/or Contractor] By:----- • -- -- ---------------------------------(Title)--------&-------- - --------------------- _-_ --------- (Plot plan, showing size of lot, location of system t relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- x --------- - ----`' *�•' -_-:----------------------- DATE---------- -�J/- -- f------------------------- REVIEWEDBY------------------------------ --------------------------------------------------------------- DATE--------------------•-•------------------------------------- BUILDINGPERMIT ISSUED-------------------------------- ------------------------------------------- ------------------------- DATE- --F------------- --------------------------------- Alterations and/or rgcommenda+ions:_-%._�__ v.-,_-------/— -c. .__�-----1' y^ l J`=`-�-` -=`'-`_---•--.��"�--'� �� �� ! ---------------------------------------------------------------- ---------------------------------------- z. -------------------------- --- ------------------------------ --------------- ----------------------------- -------- ----------------------------------- ----------------------------------------------- ----------- -------------------------- ------------------------------- ---------------------------------- ------------------------- ------- -------------------------- --------------- ------ --------------- ----- FINAL INSPECTION BY----------- ------------- --=-------- Date------------- -------- ---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Mazeltan Avo. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CU.