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FOR OFFICE USE: ----------------------- APPLICATION FOR SANITATION PERMIT� Date Issued --•- ---Permit No- --------------•--- (Complete in Duplicate) �- --- •�- � -------------------------------- ------------------------- �- This Permit Expires 1 Year From Date Issue ___ __ Application is hereby made to tate San Joaquin Local Health District for a permit to construct and install thework herein descried. pplica This application is made in compliance with County Ordinance No. 549. / ?.3 - 3bt7 Z7- ` �3 f iU Ea[ t ,cam' a "7`� s--:e_ -c- ------- �� ' ------------•---- JOB ADDRESS AND LOCATION...-__.-_ - -�- �-- //� f r---------------------------- ------------------ ----- , Address-..--••--ifl �-------40-- -------------- -------------------------------- Phone ---•-------•-•- ., Contractor's Name----�--�'.r-�--�------•-------•--.,�_..-�---•--�-----•--=--- ----------------- , Installation will serve: Residence fe - Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1---- Number of bedrooms --?--- Number of baths _L._._ Lot size ---------K-------X _/ -------------------- ---- u Water Supply: Public system ❑ Community system ❑ Private R' Depth to Water Table �,>•ft. PP Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand Q�Gravel ❑ Sandy Loam ❑ 1 lay Loam ❑ Clay ❑ ❑ New Construction: Yes l[4 No ElFHA/VA: Yes ❑ No Previous Application Made: (if yes,date-------- 1 No t - TYPE OF INSTALLATION AND 'SPECIFICATIONS.— (No septic tank or cesspool permitted if public sewer is available within 200 feet.) d-� Material /Qevv"a-`�`� : Septic Tank: Distance from nearest well__ °_r-.---Distance from foundation (� ----- Capacity--- --- No. a D ®� _Size- Disposal ize -X rX g Liquid depth v , No. of compartments--------- ------" --- r a . Disposal Field: Distance from nearest well_-J�6__.__.._Distance from foundation___:_/a___.....Distance to nearest lo+ line................. ®. Number of lines---------.--2r-------------------Length`of each line-----._747--- : -7T�Width of trench------ -�--------------------- Number ----------- . Type of filter material_---_�.i_44C.f4__Depth�f filter-material+!_----1f...___--Total length__.:_.__`___._ Seepage Pit: Distance to nearest well-"----_-.____.--_-.__Diistance from foundation_-_-_--_.-_---__-_.Distance to nearest lot line_________________ C1 ❑ er of pits. -------Lining material --------- .Size: Diameter-----------------------Depth---------------------------- " Cesspool: Distance from est well-.----_-__-...--Distance from foundation--------------------Lining material._ __-_----__.___.__---------ads. ❑ De th=-- ------------------------Liquid Capacity- --------------------------g ., Size: Diameter---------------------- _-- p I ti Distance from nearest building---`------------------------------------ Privy: Distance from�.nearest well - -------------------------- _ .ce Distance to nearest lot ine_______________________ "-------- ---------- ------ '--- - Remodeling and/or 7epairing (describe):---- ------------------- ----------------------------------- a ------------------- ---------------------- ----------------------------------------------------------------------------------------------- ----------------- :.4 ------------ ------------------ I ---------------------=--------------------------------------------: . i '" ------------- ------------------------------------------ e pared this application and that the work will 6e done in accordance with San Joaquin County I hereby certify that l have pre ordinances, State laws. and rules and regulations of,*e San Joaquin Local Health District h ��- -- .. ------. " ,_. and/or Contractor) t (Signed) - -' k� w� - - ------- -- _ - . - - --- -- ------------- (Plot plan, showing size of dot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE O LY l ZO ! I {SATE-- I__-r ' -----------+------ APPLICATION ACCEPTED BY---------"--=---------"---------r------ ----- ---------------- I REVIEWED BY---------------- ---------------------------------"--------------------------------------- ------- ------ DATE ------------ -------------------------------------- BUILDING PERMIT ISSUED----------------------------------- ---- ---------------------- DATE Alterations and/or recommendations:--5------------------------"----------------------------------------------- - ----- ----------------------------------------•-------------- -------------------------------------------------•---------- �. ---------------- --••-------------------- - I --------------- -------------- -- ------- -------- -------------- - --------" ------------------ ------------------------------ ------- ------ FINAL INSPECTION BY:------- �i i SAN JOAQUIN LOCAL HEALTH DISTRICT ti 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California i Uodi,California Manteca,California Tracy,California y