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FOR OFFICE USE: I ------------------------------------------------------ - APPLICATION FOR SANITATION PERMIT Permit No. , ... -- -------------- -------------------- - (Complete in Duplicate) This Permit Expires 1 Year from Date Issued 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. I�O . JOB ADDRESS AND LOC ION_____ l J----M---- 413-- ......---A1V -a I1V_F 'T-------/ _Pad-------f'-1> ---------------- Owner's Name-------------- ` QLr-�R.- -------- U-P4-b- r Phone. Address-------------------------- "© ' � U ----------•�Y-3--------- P =----•-------------------------------------------------------------------•------------ Contractor's Nama C 1 L •-------•----------------------------------------- ----------------------------------------- Phone---•---•-----------------•--------- y Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer_6Zii t ©_iMotel ❑ Other E]Number of living units: __.I___ Number of bedrooms __�---- Number of baths -_j---- Lot size __12_X----aQt:2__-----------_----------- Water Supply: Public system ❑ Community system ❑ Private ®Depth to Water Table J5 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 ®' New Construction: Yes ©'No ❑ FHA/VA: Yes ❑ No © N TYPE OF INSTALLATION AND SPECIFICATIONS: — t.(No-septic tank or�cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---5�.-_Distance from foundation....AO---------Material....Co R No. of compartments--------- Liquid depth_� CapacityJ-7 © _ Disposal Field: Distance from nearest well----SD-__.Distance from foundation---1C�________Distance to nearest lot line_�_�___------- Number of lines______..__�- ----------- -----Length of each line___-_ �__S�._.Width of trench--------- ?___________. � Type of filter material._.f%C_Y---Depth of filter material----.17-_______._Total length--------H4----______l� Seepage Pit: Distance to nearest well----------------------Distance from foundation___________________ Distance to nearest lot line-------._____.__ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-...--------.-_Distance from foundation----------------.--Lining material_.--__-_.---__..________.._____- - �+ E] Size: Diameter----------------- -------------------Depth----------------------------------------------------Liquid Capacity-_-----------------------.gals. Privy: Distance from nearest well-____..._____________ ______________-__--.--.Distance from nearest building------.-----------------------------...... ❑ Distance to nearest lot line---------------------------- ------------------•---------------------- ----------------------------------------------------------- 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, State laws, and rule and regulations of the San Joaquin Local Health District. / ---------------------------- ------------------------------------(Owner and/or Contractor (Signed)------Q----c'-------- ---- C.C/ 2'- T ----- ------ _. - — ,. �- —-- ---BYE---------_------=_1.__==_= - --- - ------------------ ----------------------- -�--------------------- -------------(rt -------- �----- ,.. e - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ----------- DATE-- 2 - GS APPLICATION ACCEPTED BY------ �,�---'---- ---------.---- - ------------------------ - �- ----- -•- - ------- -------------------- REVIEWEDBY----- ------------------------------- ----------------------------------------- ------------------------------------- DATE------------------------ -------------------------- BUILDINGPERMIT ISSUED----------------------------------- --- -------------------------------------------------- DATE-- --------------------------------------------------------- Alterationsand/or recommendations:_----------------------- ------------------------------------ ------------------------ -------------------•----------------------------•------------------- ----------------------------------------- ---------------------------------------------------------- ------------------------ --------------------- ------------------------- ---- ---- --------------------------- ---- ---------------- - -------------._..._--.----------------------------- - - ------- ----------------- ----------------- ---------------------------------- - ----------------------- - ,, / __r_ FINAL INSPECTION 8 Date -:_..Z -.-�oS._.... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California I F.P.CO. I.