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F R OFFICE USE: --------------- ----- APPLICATION FOR SANITATION PERMIT Permit No. ..�_l_f� �.-�. ----------------------------------- ---------------------- 1 ----------------------------- --------------------------- (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. s' v----------- -- ------------------ - -----------------1 Y---6----a• ------/-1------t------ -----/---- -------- JOB ADDRESS AND LOCATION----------------------------- •-------- Owner's Name------ '' x ----------O gX--/------------------------------- ------------------------------------------------------ Phone----_------------------------------- Address....--------s5- C--Y------------`s•-.--- 9--`f------ �- r� ------------------------------------------------------------------------------- ------------•----- ------------------ , , Contractors Name--------•-r------- -��----r---------- --------- - ----------------•----------------------------•------------- Phone--- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other R A4��iz� Number of living units: __ _- Number of bedrooms __8-- Number of baths ___S--. Lot size ____ -u_rf__________________________________ Water Supply: Public system ❑ Community system ❑ Private E- Depth to Water Table k4�— ft. Character of soil to a depth of 3 feet: Sand ❑' Gravel ❑ Sandy Loam ❑ C{ay Loam ❑ Clay B Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-------- -___--} No Et New Construction: Yes ❑ No a FHA/VA: Yes ❑ No fT ` TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest well__--------------Distance from foundation--------------------Material-------------------------------------.---.__.---. No. of compartments--------------------------Size-------------------------------Liquid depth--------------------------Capacity----------------------- Disposai field: Distance from nearest well_________________Distance from foundation------------------..Distance to nearest lot line__________--____- i��r Number of lines-----------------------------------Length of eachline-----------------------_------Width of trench-_------------.------------------•-- Type of filter material-------------------------Depth of filter material-----------------------Total length---------------------------------- ------- Seepage Pit: Distance to nearest well___1__ _a_______Distance from foundation-../Q_______-__.Distance to nearest lot line_1-____------- S In" Number of Pits---------1_---- ---"Lining material___ pc ----.Size: Diameter----y_8.-`.'-.____Depth_.- ________________ Cesspool: Distance from nearest well-----------------Distance from foundation---------- ---------Lining material-----.----------------------------,_. N ❑ Size: Diameter------------------------------------- Depth--------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance earest well-------------------_-----------------------------Distance from nearest building-_--_-_-__-___-__________________-.------ ' ❑ Distance to nearest o ------ ------- ------------------------- ------------------------------------------------------------- -------------------------------- s Remodeling and/or repairing [describe ------- ---------- OS -----------------•--•------------------•--------------------- ------------------------------------------------------------- ------------—•--- --------------------- ----------------------------------------------------------------------------------------------------------------------•------------- �—� ------------------------------------------------ ----------------------------------------•--------,--------------------------------------------------------------------------------------------------------•------------------------ 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, an rules and regulations off the Joaquin Local Health District. d / (Signed)_ _ ------- --�lc/_r_ -------------------------------------------------------- ---------(Owner and/or Contractor) 9ne - - ---- ----------------------------(owner ---------------------------------------------(Title)------------------- -------- ---------- -- ----- -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). OR DEPARTMENT USE ONLY re- APPLICATION ACCEPTED BY DATE f--�flT F REVIEWEDBY------------------------------------- -------------------------------- ----------------------------- DATE BUILDINGPERMIT ISSUED-----------------i-------------------------------------------—--------------- ------ DATE------------------------------- ----------------------------- Alterationsand/or recommendations:-------------- --- -fI.-------------------------------- ---------------------------- ----------------•---•-------------- --------------------------- ----------- --------- ------- ------------------------------- -------------- ------------------------- --------------------------- --------------------- - -•---- -•1----------------- = = -------------------------------------------------------•---------'-----------------;--------------y--------------------------------------------------•------------------------------------------------------------------------- ----------- --------- ----------- - ------ - ------------ - -------------- ------- - -- --------------- ------------- ------------------------�----------- ----------------------------------------------- -------- ---- --- FINAL INSPECTION BY: ---- 3 ------------ -- ---- Date---------------- -mss SAN JOAQUI CAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC. C .