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FOR OFFICE USE: ' APPLICATION FOR SANITATION PERMIT Permit No. r -�_ _.._...... . _:----------------- // ------------------------ ------------------------ (Complete in Duplicate} - 2-3 41 __ This Permit Expires 1 Year From Date Issued - Uate 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 co i q�g_w' C unty Ordinance No. 549. ��{� Z� S- L -Q� A)_ JOS ADDRESS AND LOCATI I�_!P - -L I-IUT O IV C� -------- 1C� ''`-t or------- �ITI� �-PC711 Z� OwnersName-------------------dQ-.I t:.. - R-N-E-1:4- --------------------------------------------------- --- ------ Phone--,-----------------------------••-- Address------------R'rS-------1---`F------box------•-- ................R-1--nnv----------------------------------------------------- --------------------------------- Contractor's -------------------------------- i ---- Phone----------------------------------------- Installation, .- , r... -=-------------------•-•-------- Contractor s Name--�-�-E-�-----�.0-�.�J-f�-�-----------------•----------------- ----------------------------- ----------- ,. Installation,will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ Number of bedrooms2__ Number of baths ---I--- Lot size --- -C_ - ---------------------------- Number of living units: -1----- Water Supply: Public system ❑ Community system ❑ Private UJ-Ibepth to Water Table 1Z ft. Character of soil to a depth of 3 feet: Sand [ XGravel ❑ Sandy an y Loam ❑ Clay Loam E] Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No © New Construction: Yes ❑ No 21---_FHA/VA: Yes ❑ No E' - TYPE-OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi�'-Il No. of compartments--------------------------Size--------------------------------Liquid depth--------------------------Capacity-------------- c rank: Distance from nearest well-----------------Distance from foundation--------------------Material---------__--__- --- -_ ---- Disposal Field:� Distance lenearest well- 5D-5D-: -Dea ratio�_ 0- Distance thestI�Enef r ��umbeof Ines ____--- - ngth of each I ne -----------Widthoftrenc � -- -- ------ r" ' TA _ ' Type of filter material---]-3i0_�—,<_---Depth of-filter material------[c .��._-.-Total length--------- --------------------------- Seepage -- ----------------------Seepage Pit: Distance to nearest well------------------ ---Distance from foundation-------------------Distance to nearest lot line-----_-----. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------------------Depth-----.--------------------------- Cesspool: Distance frcm 'nearest well-----------------Distance from foundation-------- -----------Lining material----------- ----------_-_----- ❑ Size: Diamefer'------------ ------------- -----------Depth-------:--------------------------------------------LiquIid 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 ordinancesState laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------ --------- ------------------------------------------------- (Owner and/or Contractor) BY'- ---------------••-•------------------------...----------------- - -- - -------------------------------------- -- -----"(Title}�`------=-J-- ------ - - ---- --�- ------ ---- - (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 APPLICATION ACCEPTED BY----ITf- i-.0 ----.- ------ ----------- --------------------A------------------ DATE-------�- 1 ---- -�� REVIEWED BY----------------------------------- --------- ------------------- _ Mw � - --------------- ---------------------- -- ---- DATE----- ------------------- ---------------------------------- BUILDING --------------- ------------ BUILDINGPERMIT ISSUED-------------------------- -------------- '------------------------------------------------ - DATE-------------------------- ----------------------------- Alterations and/or recommendations:-----------------=*--------------------------- -- ------------ ! ---------------------------------- ----------------- -------- ----- -------------- ------ ---------------- ------------------------------------------------------.------_ ---------------------------------------- -------------------- ----------- ---------------- ----- �I-- 1. FINAL INSPECTION- 1 - Date-� �/ -- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1 "Stockton,California Lodi,California ,__Mcnteca,California Tracy,California f