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FOR OFFICE USE:-------------- , _.ice/d%-�r--------------- �i_'3_o--.-. APPLICATION FOR SANITATION PERMIT Permit Na.� _ ...-. �% (Complete in Duplicate) --------- -- ---------- --------------------------- Date Issued __-..----------------------------- ----------------------- 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 inst I scribed. This application is made in compliance with County Ordinance No. 549, 163 — V Z,0--Is e- j -c--tea JOB ADDRESS AND LOCATION-----�j'_'_ _T=-_I_ ____ Qr __-Sl- ----- -.-=- Owner's Name �! ----------------------------------------- Phone_ . . ---�---- C'�r��. ----- Address------------ T ��a ------ --•-•----------------- ---•------- Contractor's Name-- i �-Ql`f `L 14�------------------'--------- ------------------------------- Phonefi?�11 Installation will serve: Residencejo Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __-!___ Number of bedrooms Number of baths -_.s1{___ Lot size ------------------ Water Supply: Public system ❑ Community system ❑ Private ® 'Depfh`to Water Table In ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe❑ Hardpan ❑ r Previous Application Made: (If yes,date--------------------) Nov New Construction: Yes ❑ No O. FHA/VA:.Yes ❑ No a ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well-----------------Distance from foundation___________________Material-----------------------.----_________.____.____-- ❑ No. of compartments---------- - - -----------Size------------------ -------------Liquid depth--------------- ----------Capacity----------------------- Disposal Field:- Distance from riearest well--/P(O.f_.Distance from foundation..',/�__�------Distance to nearest lot Number of lines_____________I--- .-.--_---_--_Length.-.of each line-------- __�_.. Width of trench_ _ !_-___.._----.; 7 Type of filter materiaL_�� 6J4 __-Depth of filter material---/_ ...........Total length------- ------------- Nk �' Seepage P r Distance fo nearestell.--��•0--------Distance fr m foundation__ _ _-_______-.'D to nearest lot line ----i !�J f Number of pits--!--- ---Lining material_-!"--r's��---.Size: Diameter-._---_Depth ,e--�_.____--- l _ - - .. N IL Cesspool: Distance from nearest well-----------------Distance-fr-om foundation....---------- --__.Lining material-------------------------------------- ❑ Size: Diameter-1--------------------------- --Depth -----------------------` Liquid Capacity gals. Q Privy: Distance from nearest well_____ _______________________-..._._--_---.----Distance from nearest building----------.__________________--_---__.._. ❑ j -------------------------------------------------------- ., -__ _ _'*rte Distance to nearest lot line_:.-_''r ---------------- - ------- - -- ---------------------------------- 1 �} _ Remodeling and/or repairing (describe)----- ---V -r�------- �/S--/rl----- _-----��r��41E'Y��---------------------- � I _____________________________________________________________ .. ._--___-_-____.-___________-_______________-_--__________________._--_____ _______________________--__--_----____________----_--.______.______._.._______----..__ w ____________________________________________-_______________!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 law4r-anq rules and regulations of the San Joaquin Local Health District. s i (Signed)------------- --------------- ---- � n� --- ----- ------ ner and/or Contractor) ------------------------------------------------ Bri----------------- ---------------------------------------(Title)----- - -------- -------- - -- .._...-------- f (Plat plan, showing size of lot, Iota on of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ --------------------------------------------------------------- DATE-------- ..�1-------------------- ------ REVIEWED BY---------------------------------- -------------- ----------------------------------------------------------------- DATE-_•-------------------------------------------------------- I BUILDING PERMIT ISSUED------------------------------------------------------------------------------------ ----- DATE----------------- ------------------------------------------ Alteration�nd/or recommendations------------------------------------------------ -------------------•------------------------------------------------------------------------------------------. -----------��' 9 --------Vic'- ate, ' _ ------------------- -• -- ---------------------- -- ---- ----- - -- --- ---- - ------ - Y - - - -------- FINAL INSPECTION BY:------------ 2 I Date-_.... f '�� ---------- " SAN JOAQUIN LOCAL HEALTH DISTRICT I 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 Wes"9th Street Stockton,tallFornla Lodi,California Manteca,California Tracy,California r.a.c o. -