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FOR OFFICE USE: x/03 - ---- ---------- ----------------------------- --------- APPLICATION FOR SANITATION PERMIT Permit No. /`---�-.�_.. - --------------------- ----.------------- -- (Complete in Duplicate) This Permit Expires i Year From Date Issued Date Issued _ 3.._ 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. �' 34e0_3 JOB ADDRESS A A I N- t 1 C� . f�----� - r-------- / rJ Owner's Name------ � '' ----- (+ -------- -- - -- - - --- - ----- -------- - Phone, - -�- Address-----------------------Pi. 4 S? i ° ' ��` --- -------------------•-----------------------••-• ----------..-.-------- Contractor's Name ____ '-- ight .. �.------- -- - - --- ------- ---- ---------- Phone / installation will serve: Residence [J Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms__ Number of bathsR_ ot size ___ -l� L_-----------------_._.._._ Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date....................) No ❑ New Construction: Yes Ar*"No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: Distance from nearest ell(?.U)_-__-Distance from fou afjFn-_-_�., Material��. _ No. of compartments__.___. ____ ____.Size�3-'Y— __?�__�0=_Liquid depth__,S _____-_-------Capacity... _QQ Disposal Field: Distance from nearest well_ _. .______Distanc from foundation__ __ _ .f. _.-.Distance to nearest lot line__- a. sp � e �`Q - �i�------ 1 Number of lines___ _._ �._.._ ength of each lin ------ __.Width of trench--- 47x-- -- r __ ______________ N Type of filter materia�C� l_ epth of filter material_____l "._..Total length_, -__ __ - --_t'_____-._- Seepage Pit: Distance to nearest well___________________ istance from foundation--------------------Distance to nearest lot ine-_--/� --rtP,t ' ❑ Number of pits----------------------Linin material-.--------.------------Size: Diameter-----------------.-----Depth------------------------------ Cesspool: Distance from nearest well-----------------Distance from foundation.............. ..Lining material------------------------------------- El Size: Diameter_--- -------- r- -----------------Depth-------------------------------------------------..Liquid Capacity----------------------------gals. Privy: Distance from nearest well__________________________________________ Distance from nearest building------------------__---.-___-..----.--- ❑ Distance to nearest lot line.--'---- --- ------------------ - -------- - ------------------------------------------------------------- ----------- Remodeling and/or repairing (describe)_-------------�1 `# ------------------------ = a { - R ------ --------------------------------------------------------------------------------------- r .. s i� T ------------------------------------------------------------- � -------•--------------------------------------------------------------------------------------- W = - _.. 1191YC�-- - . *A r 1 hereby certify that I have prepared-this application andltrat`& work will be done in accordance with San Joaquin County ordinances, St 4 ws, and rule tXw � of the San Joaquin Local Health District. (Signed) Sel' i: -- ---- ----------- --- - ----- -- ---------------------------- 13y:- -------------------------13 :- - _ --------------------------------f- ----- ----------- ----- --- ---- - ------- --Title ------------------------------------------------------------- (Plot plan, showing size of lot, location of system in relation to w Ills, buildings, -can(.be.placed on reverse side). _ ^��-- 'FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY........___l_.E._ _xQ-. -----------,DATE____.___7____!� _~�5 REVIEWEDBY--------------------------------------- -----------------------------------__---------------------------------------------- DATE-- --------------------------------------------------------- BUILDING PERMIT ISSUED---------------------------------------- ---------- -------------------------------------------------- DATE.------- ---------------- ---------------------------------- Alterations and/or recommendations----------------------------------------------- ---------•-------------------------------------------------------------------------•------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------------------.-..._--------- y� ------------------------------ ----------------------------- --------------------- -----•--- ------------------------------------------ ----•---------- ---------------------------------- 9 r L r- J ------------------------------- ------- -------- --- `—A. -'----------------'---#------ ---`-----------------------------------------------------------------------------.-._.-------------------------------- f:�------------- --' - - -- FINAL INSPECTION—B '- - 1 Date------- --- f -��--^Lam. --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P,CO.