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FOR OFFICE USE: _ F APPLICATION FOR SANITATION PERMIT Permit No. _..;f./�.. ---------------II '2�� - (Complt R Nplicate) �1 Date Issued - ------ --- --------------------------------- This Permit Expires TWear 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 A LOCATION------ Z_5 z�,�/ z Owner's Name------ �__--_-_��exfL------ _ -- z�r.---------, -- ------------�--------------- Phone------------------------------------ Address----------------- ------------------ ---------- -�------------------------ ------------------------------------------------------------------------�-•-------------------------------- 2-- Contractor's -'- -------- ,_Contractor's Name____ _—y - _ --------------------------.__ Phone_r Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Er '— Number of living units: ___ _ Number of bedrooms __-_ Number of baths _ _ Lot size ------`) y_il/________________-----_---__ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date-------- ________) No D----New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - ,-S;pp 'p Tank: Distance from nearest well---------------._Distance from foundation-------------------Material-------------------.----------------------------- / ri No. of compartments----- ----- -- ----------Size------------------------------Liquid depth----------- ----- -- Capacity---------------------- Disposaf Field: Distance from nearest,well__,_5_4-_'__:�Distance from foundat n---/��--------Distance to nearest lot line_._--___---- []/ Number of lines ti J___ ;7 __Length of each line_�, .--------------------Width of trench------_1? -----.- Type of filter material__,_( cc 1-__-Depth of filter material 1/ ------------Total length------ ---- ----------- _. Seepage Pit: Distance to nearest well /6 ___Distance rom foundation _ _---_-.Distance to nearest lot line __3------- EK _-EK Number of pits-_-,,-,`___ __Lining materia ____Size: Diameter____-_?�'_-f---_----Depth-__:,2_., - Cesspool: Distance from nearest well_----------------Distance from foundation---.------------- _Lining material--_________-_-._____-----._------. Size: Diameter.--___------------ --------.------De th-------------------------------------------------_Liquid Capacity gals. Privy: Distance from nearest well------------------------------------------___ _Distance from nearest building-------------------.------------------- _. ❑ Distance to nearest lot line------------------------------- --------- - ------------------------------ ------------------------------------ --------------- ---. ?� !s_ _ ! -------�-------------------- Remodeling and/or repairing (describe):----�---- ----------- ------�� ----------------------------------- ----------------------------------------------------------------------------------------------------------------------------- ------------_... I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S to laws, and rules an regulations of th an Joaquin Local Health District. (Signed)---- - -- ------- ------ -------------- ------------- ------ - - - - (O ner and/or Contractor) - By: ---- --- --- (Title) -- - - ------- -------- ---- (Plot plan, showing size of lot, location of system in relation to we-W, buildings, etc., can be placed on reverse side). F011QEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ f' '". ------ -------- -- --------- DATE_------ -------------------------------------------------- DATE----------------- ------------- ------------ REVIEWED BY------------------------ ----- ----='-4=f - - --r=�- -------------- BUILDINGPERMIT ISSUED--------------- --------------------`------------------------------- --------------------------- DATE_.----------------------------------------------------------- Alterations and/or recomm ndations --__ .._ _ __--_ __.__.___ 7 '-- ------ ------. �� yf` - -, ��-�' ��---- - •-------------- •-------------- It-14 --------------- ---------- - - - - ------ ----------------------------- ------------------------ 'LL' ---------------------------------------------- - ----------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------- FINAL INSPECTION BY:.---- -----__ �-�_._-_____.---___ Date___ ---- -_ ------------------------------------------------ S JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.