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FOR OFFICE USE; -ti-'- -------- q�9.�..... -- - - APPLICATION FOR SANITATION PERMIT Permit No. ._-__ ---------- _ --_-_---_-_------ ------------------------- - (Complete in Duplicate) Date Issued Al?.1i_� i -_-_ 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 herlescribed. This application is made in compliance with County Ordinance No. 549. 21{Or f'�D-2`j/ , i JOB ADDRESS AND LL � � � R� ��I��I��n��y� :�--f ��` --.��Owner's Name------- "1C� ------ ,l�L��`�✓:--------------------- -_------ --------- ------------------- --- Phone------------------------------------ Address-- ------•--- -•------------------------------------------------=-------•---Phone-------------------- ---------- --------•---.... ��G� ---- ----------- - ------------•-----•----•---------- Contractor's Name------- ---- - ��r------=----- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ . _4��Vr --- ---------------------------- - Number of living units: _�__- Number of bedrooms __X_.Number of baths R--- Lot size.� � � Water Supply: Public system ❑ Community system ❑ Private [waolbepth to Water Table _W/V ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Kr-_Hardpan ❑ _ .1 No [ New Constructions Yes ❑ No (5i`FHA/VA: Yes ❑ No ["— Previous Application Made: (If yes,date._------------ -- - _ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet Septic Taryk: Distance from nearest well-----------------Distance from foundation--------.____-____Material_.___...____..__.__.___...._____..___.--------- Gj�l� No. of compartments---- - ------- ------Size------------------------ ---Liquid depth-------------------------Capacity------------------- --- 10 ' --F.-_.Distance to nearest lot line_._---_---- Disposal Rf W: Distance from nearest well...(Ta. __-Distance from foundation__,_, (� .. � l Number of lines---------V_------ Length of each line 4-47 -----------------Width of trench---sr�----�--------------------- l� /_---- -- pp Type of filter material__�� Depth of filter materiaL.-sl--------------Total length-__. ��-:-.-------------------- T- See age Pit:, Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--- Numberf C of pits---------------------Lining material-- --------------.Size: Diameter---------- --- --------Depth_..-- ------------------------- ._- 1�' I Cesspool: Distance from nearest welL________________Dlstance from,foundation - material___-__...._._..._.__.______.___.____'1 ❑ .Depth--------------------------------------------------- Privy: ------------------------------------------`---- -Liquid Capacity gals.•' Size: Diameter--------------------------- --------- Privy: Distance from nearest well---------------------------------------------- --Distance from nearest building----------------------------------------- ❑ . ------------------------------------------------------ ------- --- Distance to nearest lot fine------------------------ �/fj Remodeling and/or repairing (describe):------ - ---- '. --- -------------------------------- ----------- -------------------- ------------------- ------------------ ..__ ---------- l _________________________________________________________________________..._____... ____ ____________________________________________________________ __ __________________ - --------------------------------------------------------- - -----------------------------------------------.--_________:' -----_-___-----_----__----._--_----___-----_-__----.--_-.--___-.---_.._ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lawsaandrull 's and regulations of the San Joaquin Local Health District. Si ned ....(fir Contracfior) ---- ------ -- - - - - ------------------------------------- b d ' 4 , (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can a placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- ' -------- ------------------ -------------------- DATE--- -------------------- REVIEWED BY-- ----------------------- ------ - -- -- ------- ---------- ---------- -- ------- ----------------- ----- DATE-- -- ---------------------------------------------------- BUILDING PERMIT ISSUED---------------------------------------- --------- ----------- - -- ------ DATE-------------------------------------------- -------------- Alterations and/or recommendations:--.--------------- -- -- --------------------------------------------------------------- ------------------------------------------------ -------- --------------------- - - ------------ -------------- ---- -------- --------------------- ;tr FINAL INSPECTION BY:_ ,....Z ...... ---- ---------------- --------------------------- -------------------------- SAN ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT ,. J 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 111 Stockton,California Lodi,California Manteca,California Tracy,California f.P.0 C.