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FOR OFFICE USE: _ w ------------------------------ -------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . �_Q-- --- -- --------------- --------- ------------ -- - (Complete in Duplicate) f. 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. 549. 4y JOB ADDRESS ANDEL C TI N _7Ie__��o'_...- w-,----------( at -------------------------------------------- Owner's Name _- ------ Phone-------------------------- Address - - - -- - ----x...•• -� ------------------------------------------------------------------------------- r � ..... Contractor's Name----------- -- tii -----------------------------------------•---------------------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑/ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms-_..- Number of baths -- Lot size .- '-°--------------_.__---_----.-.-.-_ Water Supply: Public system ❑ Community system ❑ Private Ve"'D'epth to Water Table 4ih+�t. 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.) Se is Tan •y Distance from nearest well-----------------Distance from foundation__-----------------Material ___-:--__----____-_---__----_`._.--------. 4'' No. of compartments- _l Size Liquid depth Capacity Disposal,Fiel Distance from nearest well.-��_____Distance from foundation-- ----------------------- ----Distance to nearest lot!rt Iine�J -_---- Number of lines___--_r---_-� .--..>..______ en th of each line--��4�-- ----------.Width of trench-s!�--------------------------- � Gni g ` Type of filter material __4� 7 epth of filter material-.-l-'7_._---.--.Total length---,�f ------------------------- �- _ . - � � Seepage Pit: Distance to nearest/well-�.�� --Distance fr foupdation--- -- --------- Distance,to nearest lot line O Number of pits-----f-------------Lining,material- fl�r_size: Diamete r__-e ft-----Depth_p: �_-___---------------.- Cesspool: Distance from nearest well.------ r--Distance from foundation--------------------Lining material------------------------------------- 1)% ❑ Size: Diameter------ ------Depth------ ---------------------------------------------Liquid Capacity- -----------------r-------gals. ' Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------.--------------------- 3 ❑ Distance to nearest lot line- ------- -------------------- ---------------------------------------- --------------------------------------------------------------- Remodeling and/or repairing describe :............ -'- -------------------------------- ------- N ----------------- .�'.�}' � 4 i f ----- '- - 1'`�-------------------- Ph -------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------------- --------------------------------- ---------------------------- --------------------------------------------------------------------------------------------------------------------------------------- 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. (Signed)----------------------� ---- ==- = :(O�f:°r Contractor) . B ------------- ------ '= -*? -n------ - --------- (Plot - - ---------- - - • -�-- -(Title}. �-:��-�-_--....... --- ..- -- (Plot plan, showing size of lot, location of system in r ation to wells, buildings, etc., can be placed on reverse side). - FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ---- --�` �'7�------------ DATE-------- - --- ----1'r-------------------------- REVIEWEDBY----- ---------------------------- ----- - -- ----- --------- ------------------------ ------------- DATE------------------------- ---------------------------------- BUILDING PERMIT ISSUED--------------------------------------- ------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations: ----------------------------------------------------------------------------------------------------------------- ------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------- --------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------- ----- f---------- ------------------------------------------------------------------- --------- -------- -I--------- -------------------------------------------- FINAL INSPECTION BY/-,A ! =_- ---' ------------------ Date----- --...--.----- ^G SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.