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f -- - _---------- f --- - i�F r APPLICATION FOR SANITATION PERMIT Permit No. ____-..... ...._• L ------------------------ ------ --- -- -- ----- --- --- ------- -- -- ------------ -'49-/�--- {Complete in Duplicate) - Date Issued - --- `- rte --------------------------------------------- __ 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 complia'rice with County Ordinance No. 549. JOB ADDRESS A D L CATION._._ -e�'Q C .G . �/�5 IIJ -------------- ----------------------------------------------- /� r o f/ Owner's Name- __�1_f� 1N -------------------------------------------------- ---- Address PhoneO-'X �� . 4 Addressf:t '* ------------------------------------------------------------------------------------------------------------------------------------------------------------ Contractor's Name---------�-----�'� _ _._----- ---------- Phone----------------------------------- Installation will serve: Residence/ Apartment House ❑ Commercial E] Trailer Court E] Motel ❑ Other Number of living units: __!.__._'Number of bedrooms --:Z-- Number of baths/_____ Lot size �__t_____._--_____________________ � Water Supply: Public system E] Community system ElPrivate in,-Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ I } Previous Application Made: (If yes date- ___.._.._-..._) No ❑ New Construction:x Yes ❑ No ❑ FHA/VA; Yes ❑ No ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation------------------- Materiaf____.____..____._______._________.._.________- 11 . p No. of compartments--------------------- - --Size---------------------------- ---Liquid depth---------------- --- ----Capacity----------------------- Disposal Field: Distance from nearest well_ -Distance from foundation_f --------Distance to nearest lot Number of lines ______.l--------------______ Length of each line______ Q____________.'.Width of trench__,-_ ------------ Type of filter material _ __. Depth of.filter material--------------------____Total length____-- ------------------------___ $eepa a Pit: Distance to nearest well__ r�___.___DiSta f.com-found tion_�7�o__.___.Dista�ce to nearest lot line__ Linin material_, tY!h9Gize: Diameter_53. . _...__. -�- Number of pits- >� 9Dept h.... 1,� ----------------- 7, 4 CAYVI Distance from nearest-well ------- -------Distance from foundation___c.`__.i __:_..Lining material__________________________________._. ❑ Size: DiameterA------------------ ----- - ---.Depth--------- ---- --- -------------- - - --------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------ from nearest building_______------ --------------------------- _\_1 ❑ Distance to newest lot.line- - ------ --- ------------------- ----------- --------------------- --------- Remodeling and/or repairing (desc!ibe):_____ -- ---- --------------_ _ CY ----- - - - --- -- ------------------- f i ---- -- - ------------------------------- 1 --------------------------------------------------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 aquin Local Health District. ice & - I _ _D �] (Signed)--- - --- ` �`'`-�--- ""` 'd------ ---------- - --=--------------- --- ----(Owner and/or Contractor) V1 BY:-- ----------- A~'--------- ----- --- - ------- ------------------ -----(Title)----------------- - ---------- -------------- ----------------- (Plot plan, s wing size o t, loc ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------------------- --------------------------------- DATE------------{ — ---------------------- ---- -- REVIEWEDBY-------------------------------------------- -------------------- ------------------------------------------------- --------- DATE-------- ----------•----- --------------------------------- BUILDING PERMIT ISSUED-------__-----------------------------------------.-------�.._-- ---- -- -----------------!DATE--------------:-------- ------------------ ----_ --- --- Alterations and/or recommendation:------ / .. ....... ________ 4:,- Z � Q --------------------- - - --------------------------------- -----------------------i---------------------- ---------------------------------•------------------------- -------------------------•------- - i C .I .<. C 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 Lodi, California Manteca,California Tracy,California F.P.CO. h�