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t. FOR OFFICE USE: , --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. • � {Complete in Duplicate) Date Issued l__��_-�. -------------------------------------------- ------------ 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. JOB ADDRESS AND LOCATION-----------.'-L 2--------iv!.-._Iva-_S,�-.�-±1 a �Y ------------------------------------------------------------------ 4 Owner's Name-------- ----- ------- ----------------------- ----------------------------------- ---- --- Phone- i Address........----. ......A.,---•----------------------•-----------••----------------•----------------------------••-•----------------------•-•-------- Contractor's Name---- :-- -------=-- -------------------------------------- ----- Phone.. ' -•'�'r-=- "' .� ---------------------------- Installation will serve: Residence [� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:---/ Number of bedrooms _2... Number of baths _2...__ Lot size __31...... 4'r ------------------------------ Water Supply: Public system ❑ 1 Community system ❑ Private [r]*'Depth to Water Table /4-r. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ET-Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date----------__----.._) No ®" New Construction: Yes ❑ No [ -- FHA/VA: Yes ❑ No t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool"permitted if public sewer is available within 200 feet.) I Septic T nk: Distance from nearest well-----------------Distance from foundation--------------------Material....--_---.._--.----_-_--..-------.----..._-.---. No. of compartments------ ------------------Size--------------------------------Liquid depth-------------------- Capacity----------------------- Disposal ield: Distance from nearest well__;,fQ-------Distance from foundation---/F-----------Distance to nearest lot line-47--___.----_ Number of fines---.--------/---------------------Length of each line_/b 7,17IS' Width of trench_-_-Xr _-_-_----_-.._-._.----_-- Type of filter material---Rrrt_Z........._.Depth of filter material----!ef-------------Tota€ length____ -------- Seepage Pit: Distance to nearest well---Z.a4_ ---------Distance from foundation--,L_4------------Distance to nearest lot li e_d_-_.__.---_._ o �- Number of pits.-._-)---------------Lining material-_-- ._-.Size: Diameter--. ____._...____Depth-----Z41--..._- ___._____--__ tj 1 I Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material_...----------------.---.-.-.---.._.- Size: Marra&er--------------------- ----------------Depth------------------ -------------- - -- - ----Liquid Capacity gals. Privy: Distance frominearest well--------------------------------------------- g----------------------------- __._Distance from nearesf building __..____... �J ❑ Disf� nceato nearest lo+ line.----- -------- --- -=--- - - - -------------------=---------- ---- -------------------------------------------... Remodeling and/or airing (describ`ee]^.^ ------------=------------------------------------------------------•-------------------------------------------------------------------------- Z I Q --------------------------------------------------------- I------------------------------------------ --- ----•------------r----------------•---•---------------------------------------- V -------- -------------- -------------------------------------------------------------------------------------- P I hereby certify that I have prepared this application and that the work will be deo a 6-accordance rdance with San Joaquin County ordinances, State laws, and rules and regulations� ,`of the San Joaquin Local Health District. -` G s i (Signed)- -- -------------------------------- --- --------------------------------------(Owner and/or Contractor) L _—---------- ------------------------------------ - (Title) (Plot plan, showing size of lot, location bf system in relation to wells, buildings, etc., can be' placed on reverse side). POR DEPARTMENT USE ONLY APPLICATION ACCEPTED' BY---- ----- ------------------- DATE------------ 1.� = REVIEWEDBY-------------------------------- .vj - - --------- DATE------------------------------------------------------- BUILDING PERMIT ISSU.ED----------- � � ---- ---------------------- -----------------------------------------. DATE---------------------------- -- -=--------- Alterations and/or recommendations:--- _ --------- ) "-- j --_----------------------=--- ---------- ----------------------------------------------- --------------- ------ } ------------------------- .�---- ----- -------------------------- ------------------------------- = - = ------------ ----------- ------`...........`- ---------------- -•------------- # FINAL INSPECTION BY:----------- -------------- --------------- Date------ f/�� ------------------ --------------------------- ( SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 1 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Ctl. .,.