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----FO2OFFICE USE. -- - 4/2 , ------ --- ---f-1/--------- -- --- --------------- ----- ---- ------._ --------------------------------- APPLICATION FOR,' SANITATION PERMIT Permit No, .......... --------------------------------------------------------- (Complete in Duplicate) -------- ------------------- ---------------------------- This Permit Expires I 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----- ....... ......... - ----------------- --------------------------------------------------------------------------------- Owner's Name-------------------- -- O"Z,( s --------------------------�', -------------------------------- -------------- P k o n e ZAP, -- Contractor's ------------------------------------- ----- ------ so - - -------- -- --------------,------------ Contractor's Name-------------------------------------------------P16 Y-r t( (�. ----- --- -- --------------------------------- ------------ Phone----------------------------------- Installation will serve: ResiclenceK Apartment House [-] Commercial E] Trailer Court [-] Motel 0 Other E] Number of living units: --_/__. Number of bedrooms J--_ Number of baths -)---- Lot size ---------�o_,>c- --------------------------- Water Supply: Public system N Community system El Private E] Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand F] Gravel I-] Sandy Loam Ej Clay Loam E] Clay E] AdobeK Hardpan El Previous Application Made: (If yes,date___?___.,--_____-) No Ej New Construction: Yes 0 No,K FHA/VA: Yes ❑ NOXI TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------ - ---------- F1I E4�-' No. of compartments-- ------- ---------------Size--------------------------------Liquid depth--------------------------Capacity-------------- -------- Disposal Field: Distance from nearest well__- ------D�stance from foundation---- ---------------Distance to nearest lot line_.______-5 I Number of lines------------ --------Length of each line---------- Width of trench---------------- Type of filter maferial:��!41_&e------ --Depth of filter material--------1S..........Total length-------------- 7-It------ Seepage Pit: Dis,tance to nearest well...------------ -___Distance from foundation-------------------Distance to nearest lot line-._---..-..---_._ ❑ ine----------------- El N6mber of pits----------------------Lining material----------------- --- Size: Diameter.----------------------Depth-----------------•--------------• v Cesspool: epth--------------------------------- Cesspool: Distance from nearest well----------------Distance from foundati6n ------ - ---- - Lining materia}_--_..___--___._._____-----_-------. taferia}-------------------------------------- I] Size. Diameter__________________ ------------_De --- --------------------------r------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------ ----- ----------------------- ------------Distance from nearest building-__--...__----_-.----.-__-___-_-__-----__ a ❑ uilcling----------------------------------------- F1Distance to nearest lot line----------------------------------------------------------------------- ---------------------------------------------------------------------- Remodeling and/or repairing (c1escr1be�:_-;';Pk—'7------- --------------------------------------------------------- ----------------------------------------------------------------------------------------------------- --------- ---- --------------------------------- ---- -- ---7---------------------------------------------------------- -------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ -- ----- - ------------------------------------ ------------------------------------------------------------------------------------------------------------------------:------------------------------------------------------------ to ,I hereby certify that I have prepared thi's-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. (Signed) - -- ----- ----------- /I- ----- -------------- -----------------------------------------------------------------------------------I---(Owner and/or Contractor) 8P----------------------------------------------------------------------------- - ----------- -----------------------------------------(Title)------------:------------------------------ --------------- (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---------------------------------- _/ ,�q_ ------------ ----------------- DATE --- --- - REVIEWED BY------------------------------------------ ------------ ---------------- DATE ------------------------------------------ ------------------ - ---------11---------- ------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------ ---------- DATE------------------------------------------------------------ Alterations and/or recommendations:------------------ ----------------------------------------------------------------------------------------------------------------- ------------------------- -------------I---•----------- ------------------------- -------------------------------------------- ---------------------------------------------------------------------------------------------- -------------------------- ------------------------------------------------------------ -------- -------------------- ---------------------------- ---------------------- ---------------------------------------------- -------------------------------------------------------I-------------- ---- - --------------- ---------------------------------- ----------------------------I-----------------I---------------------------------------- ------------------------_-•---------------•--------------------- ----------------------------- - -------------------------------- -3 - e- _'&(�-, Date........... -- ----- ------ -------------------------- FINAL INSPECTION BY:---. �: i . 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.Cci-