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FOR OFFICE USE: _____________________ -------------- APPLICATION FOR SANITATION PERMIT Permit ----------------------------------------- -- -------- (Complete in Duplicate) t Date Issued ._..._...._................................._--__ --- This Permit Expires 1_Year From Date Issued i 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, 0.5c� - 2 co JOB ADDRESS AN OCATION_ _?rt,�-_. .s -jI-I-- �r �JCJ�_._ -----TVL&A .- --- Owner's Name-------- ------ p r .......... Phone---------------------------------•-- Address----------- - -.._ ��-•--��-4-----4A. ---- ---------------R- ------------------------------------.--••--- ------------•--------------------------.------.-----.------- Contractor's Name ' ` A�Ou,a------------------------------------------------ Phone.. .-----. Installation will serve: Residence Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel E] Other ❑ Number of living units: I_---- Number of bedrooms-.3---- Number of baths Lot size _J_,0 --------------------------------- Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2T,*"H a rdpan C Uo Previous Application Made: (If yes,date--------------------} No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No [� TYPE OF INSTALLATION AND SPECIFICATIONS: l`h (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ! Septic ank: Distance from nearest we4___ 5D------Distance from foundation--.-/fi---------Material___ �-_------..--.---_-_---.-.._ No. of compartments----_y_ Size'_____ ! -Liquid depth ( - Ca pacify- br�a� Dispo I Field: Distance from nearest well....-__- Distance from foundation---14!...........Distance to'nearest lot line-5- Number of lines--------- ^SS= _.,,�------ Length of each line_�'S'� - �Q..Width of trench--- -------------------•-- S`, F Type of filter matersal-___.._ '___�_..__.-Depth of filter material____/�__ _________Total lengfih___�_aG__-:--___.___.____________- Seep ge Pit: Distance to nearest well_--__-.I6_. - Distance from foundation--__i6-__�--.- Distance to nearest lot line.___�_r_-.- 4 Number of pits--------- <__----Lining material----24 2-_----.-Size: Diameter.-..--33----------- Depth_2.'V------------------ Cesspool: Distance from nearest well----------------- from foundation----------------.-..Lining material------------------------------------- � .Liquid Capacity .-- �� + ❑ Size: Diameter Depth------------------------------------------- q P Y 9 Privy: Distance from nearest well----------------------------- --------......_Disfance from nearest building-----..--_------._---._--_-__-.___.__..._. ❑ Distance to nearest lot line----------------------------------------------------------------•----------------------------- ---------------------- ----------------- -- Remodeling and/or .repairing (describe):------------------ ----------------------------------------------------------------------------------------------------------------------- --------�'No ------------------•---•-------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------- ----- ---- --------------------------- ----------- -----------------------------------------------------------------------••-- ---------------------------------------------------------------------- ----------------- ------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, rules and regulations of the San Joaquin Local Health District. (Signed) - -------------------------- -------- i - ------------:------------------------------------------------- r Contract ---(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--- -------------------`r ------------------------ DATE----4.71 _4. ---------------------------- REVIEWEDBY---------------------------------- ------ - - ----------------- --- - -- ---------- ------------ -------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------ -------------- ------------------------------------------------------------------ DATE----- ---------------------------------------- -------------- Alterations and/or recommendations: - = f -----------=-=-------------------------------------------------•-------•------------------------------------------------ --------------------------------------------------------------------------------------------------- -I---------------------------------------------------------------------------------------------------•------------------- ------- ------ ---------- - - ---- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ ----- -------- FINAL INSPECTION BY:. -------- ------- Date... --------- ------- -------------- --------- ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Mazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.r.C3, i