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FOROFFICE USE: --- -- ------------------------- /G-------------------1 ----------------- APPLICATION FOR SANITATION PERMIT Permit No. y ---------- (Complete in Duplicate) ------- -------------- ---------------- --------- - -- -- I This Permit Expires 1 Year From Date Issued Date Issued zj_-S -- 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 ADDRESS AND LOCATIOOC ----------- ----------- -- •'�L,� Owner's Name. G ?Z� ---------------------- ----- Phone Address---------------- - - --— : ------ ----------- -----r Contractor's Name___________ __ -- Installation will serve: Residence ®RApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __`- Number of bedrooms _. _ Number of baths __:?�'Lot size __. _._ ____ �----- ----------------- Water Supply: Public system ❑ Community system ❑ Private [24--15epth to Water Table%5 ft. Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay P ❑ ❑ Y ❑ y ❑ y ❑ Adobe �ardpan ❑ Previous Application Made: {If yes,date____ ---------------) No 9----New Construction: Yes ❑ No [A-'_FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: } t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e i nk: Distance from nearest welf---- ----------Distance from foundation-----------------__.Material-- ___--__....------------------------------- ---- ------------------------------ No. of compartments ----Size---------------------------- ---Liquid depth---------------- ---------Capacity-------------- t r T _/ 1 Disposal field: Distance from nearest well-_+:] Distance from foundaficn._3� Distance to nearest lot line--�__-_--_• ❑� Number of lines------- ----------- Length of each line-------;?Z3.- ---------- Width of trench.------.2,$.�_"--------._-- Type of filter material_ ,_ 0(_ -��---Depth of filter material_ _ / ' Total length___. -- / Seepage Pit: Distance to nearest well _/ --____-___Distance foundafion____.5_�.______.pistance to nearest lot line----- -?------- [!� Number of pits------/..__.-------Lining material-- C(' -Size: Diameter-_-. .f� p �1 ` I Cesspool: Distance from nearest well------------_____Distance from foundation_______---__.-..._..Lining material_--____._..__..___-_ �a ❑ Size: Diameter------------------------------ -------Depth------ -------------------------------------- ------Liquid Capacity -------gals. Privy: Distance from nearest well___----_____________._-__---_--. ...__..____--- _Distance from nearest building ❑ Distance to nearest lot line------------------------ 1 Remodeling and/or repairing (describe):-----.----------- -- --------------------------------------------------------------- t ------------------------------------------------------------------------------------------------- -------•------------------------------------------------------------- ------- ---------------------------- - - : i A I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta laws, and rules a d re ulations of the Sn Joaquin Local Health District. (Signed)---- ------- and/or :..� --------- w er n r Contract BY� - " - --------(Title)-Pced - (O� ----a- d/o or) (Plot plan, showing size of lot, location�_f system in relation to ells, buildings, etc., can be pl reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY--- ------ REVIEWEDBY-------------------------------------------------- DATE------ ----------------------------------- ---- BUILDING PERMIT ISSUED -------- - =--------------2------_------------- DATE--------- -------------------------------------------- Alterations and/or recommendations:--------il/ >_ a ll ---------------- - -------------------• ----------------------•----------•-------••-----------------------------•--------•------•--------- ------------- ----------------------- ------------------------- - --------------------------------------------------- ------- --------------- ---------------- --- - - �� / if FINAL INSPECTION BY:...-----/� '�.. G1. '_---- D -- ate. -------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 1.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California