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FOR OFFICE USE: -- ---------------------- --------- a APPLICATION FOR SANITATION PERMIT Permit No. ------------------ ------------------------ 3 ------------ ----- ------------------------ - --- (Comple+e 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. S49. f JOB ADDRESS AND LOCATI N--?P.e4 ----� 1 "t / f{/--------------------st;5k -------------------------------- Owner's Name------------ e-----tm-��10's�------------------------------- - --------------- -------------------------------------------- Phone--- ------------------------------ - Address---------- ,�j��' = -----�---------------�---�----.---�----------------------------------------------------------------------------------------------`;---------------------------- Contractor's Name.------------- .f '=y{ '' =------------------------------------- -------- Phone---------------------.._...-------- Installation will serve: Residence PT-*"Apartmen+ House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ - 10 .111 Number of living units: _ _-- Number of bedrooms___ Number of baths <_ Lot size'cY_o':UVe1 ----------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 4?e.,F ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay E] Adobe �Iardpan ❑ Previous Application Made: (If yes,date...-----------------I No R-""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 fee+.) Septic Tank; Distance from nearest well_________________Distance from foundation------------------- Material------------------------------------------------- No. of compartments-. -----------------------Size--------------------------------Liquid deP.h---------- -- - -------. Capacity----------------------- Disposal Fi Id Distance from nearest well----- ----Distance from foundation___-_ i __._--Distance to nearest lot line._Ae/._ Number of lines________ ________ Length of each line ' f�- Width of tren h-. -------- - f ------- T e of filter material-,� 4 De th of filter material___ ._ .__� Total len th_l_a --------- ---%/__ Seepage Pit: Distance to.nearest well_-xAl......Distance fr m foundation---(__f'-_______.Distance to nearest lot•Ie._��_------- Number of pits----/---_________--Lining material- __.Size: Diameter.__ 77 ------Depth-'9�J.---/of Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___-------------- ____------_--_..__. ❑ Size: Diameter----------------- - - ------ - ------Depth-------------------------------- --------- - -----Liquid Capacity----------------------------gals. G4 Privy: Distance from nearest well__. -- _____________________________Distance from nearest building--------------_-.____._-_________..__---- l ❑ Distance to nearest lot 1ine............... ----------------------------------------------------------------------•- ----------------------- --------------------------- Remodelin and/or repairing describe --- ------ - ___._ _ ` -----------------------------------------------------------------------------------------------------------------------------•---------------------------- ------------------------------------------------------------------ - ---------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. r (Signed)--------------------------------lee —------- ( /or Contractor) r By---------- ---------------------------------------------------------- ---- (Title}- /ehG �------- ---- ---.. ----------------- (Plot plan, showing size of lot, location of system in rel i n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- -------- ---------------- ---------------------------------------- DATE-------- -'-; 1G---------- --------------- - REVIEWEDBY------ -------------------------------------- - ----------- ---------------------------------------------- DATE-------------------- BUILDINGPERMIT ISSUED------- •---•--------------------------------------------------------------------------------------- DATE--------- ------------- Alterations and/or recommendations: ----------- ----------------------------------------------- ---------------------------------- ----------------------------------- --------------�-�° ------------------------------------- --------------- - ------------------- ------- - - - y:_�. - ------`-`'� ------ -------------- --- wx------------------ ----------------------- ------------- ------- -------------------------------------------------- ---------------------- ------------------------------------------ -------------- ----------I------ -- ----------- ----------------------------- --- ---------------------- --y------------------------------------------------------------------ FINALINSPECTION BY:- -- --•------------------------------------------ Date...........1..--l` �° ----- --- ------ ----------------------------- , SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California