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FOR OFFICE USE. ------------------------------------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. ._ �.3 ------------ ------------------- ---------- -- (Complete in Duplicate) __ ---- � This Permit Expires 1 Year From Date Issued Date Issued1-- ` Application is hereby made to the Son'Joaquin Local Health District for a permit to construct and install the work herein described. This application is.made-in-compliance.,with,Co nty,Ordinance No. 549. `7 w_-_+'�rw L� JOB ADDRESS AND LOCATION ✓1��,----1�- �'------------------------� - '------r� �( � .4��- -,--------.- - 1 Owner's Nam _ r________ ..-------- f t Phone Address. - ------------------------"------!""-- � -- --�-----�V_��--------------` •--------- ---•--------.--- Contractor's Name----------- �� -_-_ ---------------------------------------------------------:..----- ------------------------- . Phone----•-------•--------------------- .. Installation will serve: Resident Apartment House ❑ Co+m rcial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: _-- -___ Number of bedrooms _-_- - umber of baths -----__ L;t size -------- _-----_-..5---------------------------------- Water Supply. Public system ❑ Community system ❑ Private Depth to Water Table ft. �g Character of soil to a depth of 3 feet: Sand ❑ Gravel ;Sandy Loam F] 'Clay Loam El Clay ❑ Adobe ❑ Hardpan F1Previous Application Made: [If yes,date--------- ) No New Construction: Yes ( No El FHA/VA: Yes [:1 No TYPE OF INSTALLATION AND SPECIFICATIONS: T—(No septic tank or.cesspool permitted if public sewer is available within 200 feet.)y a � Sep is Tank: Distance from nearest well----/ Distance from foundation---- terial -.- --. -.- } a ` No. of compartments-------' -----------Size__-3_ 7�'k a ------Liquid depth------ --------------f.-Capacity---I -f_------ - ,- Disposal Field: Distance from nearest well__/a-_C___Distance from foundation.../--2'�Y--.Distance to nearest lot line-- --. -_-_-+ Number of lines----------! ________-.__--___.__,Length of each line----__.._I- -; `f---.Width of trench.-----94` - - --------------- Type of filter material__.--J_--)Depth of filterlmaterial------ --C ,!`---.Total length---------- ---------------- Seepage Pit: Distance to nearest well--------------------_Distance from foundation--------------------Distance to nearest lot line__-_-.-_.--_-_ �} ❑ Number of pits----------------------Lining material----------.------------Size: Diameter---- •----•----------Depth--•------------------------------ Cesspool: Distance from nearest well-----------------Distance from foundation------------------.lining material-_-___------.-.----_---.------------. ❑ Size: Diameter----------------- --- ----- ...Depth---------------------------- ------------------Liquid Capacity----------------------------gals. '" ` st "� � '--� �"""�' "r Distance from nearest buildin Privy: Diance frorri nearest well---- -- -------------------------- ;A--------- g----.---- - ------------------ - ❑ Distance to nearest lot line-------------------------------------------- ------------------------- -------------------------------------------------- -- --------------- Remo de ing and/or repairing (describe=•--- --------'�---- �-------'--- ---� •_-- ------ --`- ---------�--- f------------------------ --- -- --- -= ----------- ----.----- = - ------ ---- ----- --------------------------- ---------------------------,�--- ----------------.-----:------------------------------------------------------------------------------------------ ---------------- - -- ---------- ereby certify that I have prepar d this application and that the work will be done in accordance with San Joaquin County ordinances, S ate laws,'and rules and regulations of the San Joaquin Local Health District., (Signed) ------ -------------------------------- Owner and/or Contractor ------------------- - - Title -------------------------------------- (Plot-plani showing-size-of-lot,-Iocation-of-system in relafion to wells;buildings,---etc-�can-be-placed�-on reverse-side}:T-- FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------------------------------------------------------------------------------- ---- -- ----- DATE----------------------------- ---------- --------- REVIEWED BY------------------------------- -- ------------------------- ------------ --------------- XTE--.-- BUILDING PERMIT ISSUED - --- DATE------- ------------------•--------------------------------- Alterations and/or recommendations-------------.------ • -- - --- - - w . s ---------------------------------------------------------------------- ------------- - ---------------------------------------------------- ------------ -•------- ------------------ ------ ------ ------------------------ ----- ----• f ------------------------------------------ r� � FINAL INSPECTION BY------ - ---- - - r------—----------------------- ---------- Date----------------------------- ............./----------------- ------ L SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street '305 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California '� — — F.KCC. s