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I-UK UI-HU: U5E: ------ -------------------------------------------- - t� "5 ------------------------_--------------.---------- ------ APPLICATION FOR -SANITATION PERMIT Permit No. ------------------- --r------------------------ ---- -- (Complete 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. 549. JOB AQDRESS ACAT - - - - - -- --------------------------------------------------------------------------------------------------- t Owner's Name ` Phone: Gr. .�zo.`�'d Address ---•- ----------- -------- •-------------- -----------------------------------• s- �j�,� Contractor's Name ----------&_ Phone----------------------------------- Installation will serve: Residence [a�Apartment House ❑. Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/_ Number of bedrooms ,q---Number of baths -_{-_ Lot size ,/,g �_�......_-._____.__..__________________ Water Supply: Public system El Community system E] Private D9�pth to Water Table �-J_�lP_ tt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,dole__------------------) No New Construction: Yes ❑ No [7?--FHA/VA: Yes ❑ No [ � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Ta :- Distance from nearest well-----------------Distance from foundation...........-.__-.-..Material_---------_____-------____--....- No. of compartments-------------------- ----Size----------------------------:---Liquid depth------------- -----------Capacity----------•----------- Div�osalrField;, Distance from nearest well----- - ---------Distance from foundation--------------------Distance to nearest lot line.-__-._..--._.- lGG Number'of lines-----------------------------------Length of each line...............-------------Width of trench-------------------------------•-- Type of filter material-------------------------Depth of f lfer material---------------------._Total length__-..-....__..__ ------.__-_-...- oe Seepage Pit: Distance to nearest well.... Distance fr fou dation__ ___..._. - �..._.. Distanncye to nearest lot lire-tj...------- �/' Number of pits..---/------------Lining materialL�.Size: Diameter.-.,.F-3_.._... De fn s P �-------- - Cesspool: Distance from nearest well- --_.Distance from foundafion--_-_.___--_--....Lining material------------------------------------- U ❑ Size: Diamefer-----------------------------=--------Depth-------------------------------------- ------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well_---------------------------------------------Distance-from nearest building----------.___-_------._-__-_-_--------- 3 ❑ Distance to nearest I& line--- ------------------- Remodeling -- -----------Remodeling and/or repairing (describe):------ -- ----- d�G'��"------ --- -- - - ------- - --- ----------------------•- ---------------------------• 0 ------------------------------•------------------------------------------------------------------------------•---------------------------------f----_--------------------- - ,5 ------------------- --------------------------------------- I----------------•------------•--------------------------------------------- ---------•----------------------------------------------------------- ------------------------------- 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 Joaqui Loa H alth District. t. �I F - (Signed)-- ------------ --------------------- -� ----1/�-"---�---- ------------------------------ -------(Owner and/or Contractor) 1 4 i _ By -------------------------------•-------------------------------------------------------------------------------------------(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-- .h 3 ,. -------------------- DATE 1 REVIEWEDBY ------- ------------------------ --------------------------------------------------- DATE----- - BUILDINGPERMIT ISSUED--------------------------------------------- ----------------•------------- ------ ----------------- D,ATE---------- ------------- t + Alterations and/or recommendations:__-"I_•..q low............... --_--��--_-,__ �! CC�� ,�, -------------------------- -------------- ------- f _ /� r ----- -----.-. - u. : . ¢ k a - - - ,� , AL ------ ,°�� ------------- --------- - ................................... __--------------- ------ -- ----------------------.--_.--- -----—..----------------------- FINAL INSPECTION BY--------- --------- ------------------------------------------- Date--------------------- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California t Lodi,California Manteca,California Tracy,California F.P,Cci. �t