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FOR OFFICE USE: i ------------ a �. ------- --" ------- ----------------- ----------------- APPLICATION FOR SANITATION PERMIT Permit No. ------- ----------- ----- ----� ---- - This Permit ExpiresCplete in Duplicate) Date Issued pp _-----_- ------- .- q 1.Year FromDateIssued Application is herebymade to the Sani Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in complianceiwith County Ordinance No. S49. JOB ADDRESS AND LOCATION �_`�r°---`-�-----C- -----�`-e -- Owner's Name------------------------�'o-J_.!-__-._------------------------------------ ----- --------- ------ Phone---------------------------- - Address = T ,�a vC---- ° `SO '' �- �' -----_.. Contractor's Name f`� ' 'SsJrs ----------------------------------"---- - ------------------------------- Phone-- e Installation will serve: Residence R (Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _f_ Number of bedrooms __Z___ Number of baths J---- Lot size 'q<_-_" ____________________________ Water Supply: Public system 0-- Community system F1 private F1 Depth to Water Table Es. ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe El- Hardpan ❑ Previous Application Made: (If yes,date--------------------) No D- New Construction: Yes ❑ No FHA/VA: Yes ❑ No E3— 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__-f—'_----Distance from foundation__.....Material____________________________________________.__. No. of compartments--------------------------Size------------------ ------------Liquid depth------- -----.Capacity----------------------- Disposal Field' Distance from near'est well...!�_-._Distance from foundation___1_0_f--------Distance to nearest lot line_ ........ .ems Number of lines----k_______-I--------------------Length of each line------ Q,- -------------Width of trench------2--_'.----•---_-------.------ Type of filter materiaL____I ------Depth of filter material-----/R_"____.-Total length-----gip------------------_____._____ G� yl � �• � V Seepage Pit: Distance to nearest well.-.--4-—'--------Distance from foundation----- .i�_ .......Distance to nearest lot line---S---------- � Number of pits.-.._A-------------Lining material------14._<�<___,:.Size: Diameter.---_33_••---_--Depth-----��`'-�----------------- ., t Cesspool: Distance from nearest well-----------------Distance from foundation- __-.---"...---..Lining material__________ _________________________ Size: Diameter--_ .__._.__ ❑ I = ..Depth - Liquid Capacity ---------------------gals. f Privy: Ij Distance from nearest well------------------------------------------------Distance from nearest building.____._._____._____.._______-.._____._._. l ❑ Distance to nearestlot line.------------------- -------- --------- ------------------ --•---- ------------------------------ Remodeling and/or repairing Idescri4-e):------------ --------•--------------------- ------------ --------------------------•--- -------------------- -"------------------------ it ------------------------------------------ II I ------------------------------------------------------ ,1 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 the San Joaquin Local Health District. I II I -------Owner and/or Contractor(Signed) .----------- (Title)By:------- ------- ------------------------------------------------------------------------ (Plot plan, showing size of lot, location`of system in relation to wells, buildings, etc., can be placed on reverse side). r ]. FOR DEPARTMENT USE ONLY " APPLICATION ACCEPTED BY---------- -------- Gu1 -- ------------ ------ DATE-- -- _ ---_-G__.�� REVIEWED BY---------------------------- i ------ DATE------------------=----------------------------------- BUILDINGPERMIT ISSUED---------- ----------------------------------------- t-------------------------- DANE------------------------------------\- ------------------ Alterations and/or recommepdations:- --- _�-I_j..6___6-- --------- ------ � :_a__s_- -------•-I --- ------------ --------------------- `�.� ---``-----6�- --�- -- �----------------------------- ---- ' I 1 'j I ------•---------- --•------------------------------------------------------------ -------- ----------------- FINAL 'INSPECTION BY:.................. --------*" ---------------- Date-------` I' SAN JOAQUIN LOCAL HEALTH DISTRICT u 1601'E.Na:eltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 'i Stockton,California Lodi,California Manteca,California Tracy,California i i� M