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FOR OFFICE USE; ------ ----------------------------- --------------------------- APPLICATION FOR SANITATION PERMIT Permit No. / _ ------------------------- - (Complete in Duplicate) V-,_ ---_--------------___________V-._--------.____.____ --- This Permit Expires 1 Year From Date Issued Date Issued. Applicafion is hereby made to the San Joaquin Local Health District for a permit to cons®rucOinstall the work herein described. This application is made in compliance-with h County Ordinance No. 549. �.� JOB ADDRESS AND OCATIONr� 7074 ____ _.__ ___Y-��c��? -___ �----.- Owner s Name------ ,/�• A : ----------------------------------- dbPhone------------------------------------ Address------------------- ----------- -Address------------------PIi= ------------------- ------------------------------•----------------------------------------- --------------------- Contractor's Name..--- --------=---•-------••-------------------------------------------=-----------------•-------------------------------- Phone----------------------------------- Installation will serve: Residence IV Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ � Number of living units: -1---.- Number of bedroomsS_---- Number of baths �_-- Lot size .3 �...._..kr_k------------------------- Water Supply: Public:system E] Community system ElPrivate W Depth to Water Table ��. ft. Character of soil to a depth of 3 feet: Sand ❑ 'Gravel ❑ Sandy Loam ❑ Clay Loam W Clay ❑ Adobe ❑ Hardpan.® -- Previous Application Made: (If yes,date--------------------) No M New Construction: Yes NJ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__ y.8. -----Distancr _ t1 _; No. of compartments-----1----------------Size-V�-fFtJ---------'Liquid depth------Al---------------Capacity-/;"P'V.------- Disposal Field: Distance from nearest well_. d�__:.____Distance from foundation_-_ZP-_-------.Distance to nearest lot line__!C---___- Number of lines___... Length of each line-----,� Width of trench----�' -- ----------------------- T a of filter material __ Depth of filter material-- _ ----__-___--_.Total length-_ ---------------------------- A714 _ .. Yp -- - - p Seepage Pit: Distance to nearest well_._-/_llv__._.---D-:stance from/oundation-1A'-___.._.Distance to nearest lot line e_.S__________ ] Number of pits._.a�---------------Lining material-1LvP_---------Size: Diameter.-.__473_............Depth___P^ ---------------__ -._. Cesspool: Distance from nearest well----------------- from foundation....__._-____.__.__.Lining-material-------------------------------------- F1 __-._.- _-_---_------_.---_-----. ❑ Size: Diameter------------------------- ----------Depth------------------------ - ---Liquid Capacity----------------- ----------ga€s. Priv Distance from nearest well--------------------------------------------------- Y� Distance -from nearest building------------------------------------------- Distance ---- - --------------------------------- Distance to nearest lot line- ------- ------------------------------------------- ----------------=------------------------------------------------- --- - r 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 San Joaquin County ordinances, State laws, and rules and regulations of the San .Joaquin Local Health District. I I (SignedB-------------- --------------------------------------------- --- •- -------._..Y�-,;P;.-_-�-.-,-------�---T----:-_-----__:------t----- - Title - ---[Owner and/or _Contractor) i -- ------------- ------- --- -- - ---- ------- ----- ---- --------------- -- r------ _ ( l - - --- -------------------- - - (Plot plan, showing sae tf lot, lacatio�of system in relation.to wells;buildings;efc., canTbe placed on re4e*se`side).`"''^ = '- FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. __ __ -> ___________________.___________ DATE ---------------------------- ---1 REVIEWEDBY------------------------- -- _ ---------------------• - -- --- .-----•- DATE------------------- ------ BUILDING PERMIT ISSUED---------------------------------------- ---------------- DATE--------------------------------- ------------------------ Alterations and/or recommendations:------------ -------------------- ------------------•---•----•----------------------•--------------------•------------------------ ------ ---•---------------------------•--------------------•----------------- ------------------------------------------------------------------------------------- --------------------------------------------------------------- 4 .----•----------------------------•-_._-.__-.--___.._...--.--...._------._....------.._-------.-.-_------____- _- -----.-----------------------------.-------------.----------- ---------------------------------------- -------------------------- ----------------------------------- ........ ---------------------- -------------- ------------------- ----- "---------.._...--..-._ - - __ 9- - G�3 FINAL INSPECTION BY:- --- --- Date------------ --- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellen Ave. 300 West Oak Street 124 sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 4 REVISED B-59 3M 3-'63 F.RrU. k