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FOR OFFICE USE: «� 3� y/ ��---� l APPLICATION FOR SANITATION PERMIT Permit No. ...-1.- �-. . --------------------------------------------------------- i (Complete in Duplicate) 3 r Date issued _.___-.--_ F 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-----�--`�¢- ?-�---�-'----9- ------------- --------------------------------------------------------------------------------------- Owner's Name------ ------,z'1-krt-'7--),.,.,--e_l!�----------------------------- - ---- ------ ------------------------------- Phone__- ---`-Y-`Z--7 1 � Address-------------- -Z.L ----- --------- ------....-------------------------------- Contractor's Name --- ------------------------------------------------- Phone-- y.�-f�..'-- ....- Installation will serve: Residence Apartment House House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms __.Z__ Number of baths __/.___. Lot size ---------- o ------------------------- Water Supply: Public system �Ca munity system ❑� private [j Depth to Water Table -------- ft. + Character of soil to a depth of 3 feet: Sand El Gravel E] Sandy Loam E] . Clay Loam E] Clay ❑ Adobe s& Hardpan E]5 Previous A lication Made: (if yes,date...- _...............] No [z-} New Construction: Yes E] No [G} FHA/VA: Yes ❑ No pp 5 y 1 3 r r TYPE :OF INSTALLATION AND SPECIFICATIONS: f(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Ii Septic Tank: Distance from nearest welL____._______,__Distance from foundation___________._.__..Material-------____----------___________________________ No. of compartments -----------------------Size-------------------------------Liquid depth-------------- -----------Capacity----------------------- Disposal Field: Distance from nearest well_/Iwh-- _Distance from foundation..../..a--------__.Distance to nearest lot Number of lines!------1-1---------------------Length of each line---------J_a . . ------.Width of trench-------•- - ---------- I Type of filter material14P�*x ..___Depth of filter material_____✓sY�'---------Total length___._-__- d--------------------------- Seepage Pit: Distance to nearestDistance from found __ ation �A__f_______-Distance to nearest lot iine__;T•J-------- + ❑/ Number of pits_____-.__--------Lining material___. _Size: Dia meter__._j.`..____._.__.Depth..-. —_________________ Cesspool: Distance from Clearest well_________________Distance from foundation--------------------Lining material-------_.------.____.______.______.__. i •❑ Size: Diameter----- -----------------------------Depth--------------------- --- --- ---------------- ---Liquid Capacity----------------------------gals, Privy: E3is# c n_eares+ well------------------------------------------- - --Distance from nearest building--_-------------------------------------- Distanceto nearest o m - --------------------------------------------------------- ----•--------------------------------------------------------- { Remodeling and/or repairing �d e --°----------------------------•--------=---------------- --------'---------------•---------------_--- ---------------------------- 1 I -j ..� � I hereby certify that I have preared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,,-and rules and regulations of +he San J a uin Local Health District. S ---- ------ By: _________________________________ (Signed)---------------- _ ------`--------- --- -----t (Owner and/or Contractor) Plot Ian, showing size of lot, 1�tipof s s+em in lation to wells,---------- buifdin s, etc.., can bele---------------------------------------------- -- ---- --------- � ( p g yg placed on reverse side). ( FOR DEPARTMENT USE ONLY , a APPLICATION ACCEPTED BY-----. ------------------------------------ - - - --------- DATE.---'!,----- ---------------------------- REVIEWEDBY---------------------- --- ----------'------- ------------------------------------------------------------------------------• DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------- =I-------------------------------------------—------------------------------------- DATE----------------------------------- ----------------------- Alterations and/or recommendations- ------------ ----- -----------------------------------------------------------------------•------•-----------------------•----------•----------•-------- ---•-•------------•------------------------- --- ---------- ---------------------------------------- -- ------------------ ---------------------- -------------------------•-------•--- ---------------------------------- " ---- ------- ------------------------------- . ._-3 FINAL INSPECTION BY: --------- -r.------- - ------------- bate - -- --- "*� s r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kazetton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.F.co. x