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------------------------------------- ------------------- --------------- ------------- -------- - - ------ -- - --- -------------..._..,-----____..--------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------------------ ------------------------ ------- (Complete in Duplicate) -------------------------- This Permit Expires 1 Year From Date Issued 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�e jP pliance with County Ordinance No. 549. _i 1 1' f JOB ADDRESS AND LOCATION------------ 3_ - I_�( ---- .S�-rTREE�----- -•--------------------------/ }T -} 0�------------- Owner's Name------PH l-L L l.Q C'OJ�-7V V cr/at-,— CO.-` Phone. --------------------- -------- 'Address ��_ / LM f}� 110- ----- 1Q7f-TO ---------•------------------------------- Contractor's Name---------ruL.._lc.E$,------------------------------->---�i Phone.. ,q11 Installation will serve: Residence Apartment House Commercial ❑ ❑ r'Oflier ❑ ? ^^��___ Number of baths __I_--- Lot size __-_____ Number of living units: ---I---- Number of bedrooms t,�t ( 7�-�_-_�-�_�------------------------ p ❑ Trailer Court Motel Water Supply: Public system l!<Communify system ❑ Private ❑ Depth to Water Table _I0 ft. ,V1 Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El'Clay Loam ❑ Clay ❑ (dobe ❑ Hardpan ❑ r Previous Application Made: (If yes,date--------------------I No E�'New Construction: Yes [k—TVo ❑ FHA/VA: Yes [�J' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic Tank: Distance from nearest well-Of-W----Distanc from foundation___149-•------.Mater al-----6QNCR E'f.�-------� No. of compartments-------2------------Size_-- X_�D-X-��-Liquid depth__ .. ----.'Ca paCity __1_z®_ ___ Disposal Field: Distance from nearest welL.0-V/.__D' an f om � 'dation___It _-. ---.Distance to nearest lot liner4406� fs_ 0' Number of lines------3------------------- - L gAo�e3ach n - --------------------- -._ idth of trench---------��a-___ it / /y Type of filter material-- -- 0. ---Depth of filter material----�q---___.____-Total length--------rr /_9V_ Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line----------------- \ ❑ Number of pits'=------x._----_--Lining,mmaterial.__--------------------Size: Diameter _��-_ -------.-• Depth-------------------------- -----_- Cesspool: A;�;Dis{ante fro nearest well----------------Distance from foundation-------__.-____-._-.Lining material---_-.__---__-----_______--_--.----- ❑ Size .Dip --------------------------------------Liquid Capacity------------1--------------gals, d ameter.------F �-�---------------------Depth --- --- - ,-Privy: Distance from nearest well-------------------------------------------------Distance from neares+ building__----__.___.___----------_---_.-____-_. ❑ Distance to nearest lot line----------------------- ----- --------------- ----- -----------------I Remodeling and/or repairing (describe):----------------- -----------------------=-------------------- ----------------- •---------------- ------------------------------------------------ --------------------------------------------------------------•-------------------------------------- -----------,- �--i------------------•--------------------------------------------------------- --------------------- ------------------------------------------------ ---------------•---------------------------•-------------— ----------------------------------------------------------------------------------------------------- - ------------------------------- ------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in,,,accordance with`SaA Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ed 4�/ L1/ ' (Sign }-- -- • -.��--,.----•-----'- - --- ----------------- ------------------------------------------------------ - - (Owner and/or Contractor By:------------ --------------------------------------------------------------------------------•-----------:-.--------- {Title} (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 ^- FOR DEPARTMENT USE ONLY }� APPLICATION ACCEPTED BY 1 r R•0 ----------------------------------------------- ------------------ DATE--------- --� i� �o REVIEWED, BY =-------- ----- ------ ------- ------ DATE___._`----- -----------------------_ BUILDINGtPERMITISSUED--------------------------------------------------------------•------------------------ -------------- DATE------------------------------------------- Alterifi&ni and/6-r-recommendations:. = -------------------- ------------------------ I -------------- ------ --------W----- ---------------------- --------------------- ------------- - ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECT Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C f7. 9