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FOR OFFICE USE: --- --- r APPLICATION FOR SANITATION PERMIT Permit No. ---------------------- ----------------------- ..1.: .__ -------- --------------------- -------------------------- (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. JOB ADDRESS AND LOCATION-... l - J�� ----44_. ...= .. Owner's Name----------- J -- v'___{.__ f-- - Phone----------------------••-------_-- Address----------------�i ._ _ ... �1?1.�l71� C-------------------------- ------------------------------------------------------•-•-----------------------•----•---- Contractor's Name---------------- 1 ------------------------------------------------•---•---------------•------.- Phone.....-_..-----:-_----------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _. Number of bedrooms -- Number of baths cad_*Lot size %.- ' '--------______________________-__ Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table --uTot" Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2--nardpan ❑ Previous Application Made: {If yes,date-_-----------------I No gr New Construction: Yes 2- No ❑ FHA/VA: Yes [ter' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest we ---_.Distance from foundation----1 •-------.Material---- ---------- - _ ----- ------ No. of compartm �_____._----------SizeAA � --.Liquid depth-- -,�f----------___._Capacity_IC2.- 0B------ Disposal Field: Distance from nearest well - _..._.Distance from foundation----z®_.........Distance to nearest loft iine__�--__- �' Number of lines________ _____ _____ _------------Length of each line_____ _-__� � - - ��----------------Width of trench------------i-------------•----•- Type of filter material/V ___ __Depth of filter material-- _-_---------Total length_____ _______________'__,- (� Seepage Pit: Distance to nearest well-------�_=--`,--Distance from foundation___,-40---------Distance to nearest lot Iline---�____-- `# ,Number of its.-___-q_ ___Linin material_�1k4A----_.Size: Diameter---%f __.De th -- b______ ' Cesspool• Distance from nearest well------------_.-Distance from foundation___-----------------Lining material______-__________________________- ❑ 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):--------------/t'- W_- ---� � i ------------•--------------------------------------------------------••-----•--------------------------------------------------- ---------------------------------------•----------•----------------------------------- -------------------------•-------------------------•----••--------•-------•-•----•----•-------------------•-----------------------------•-••---------•-------••----•-----------------------------•----•--•---------------- T 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 rules and regulations of the-San Joaquin Local Health District. (Signed} --------------- / {� �" ',�/--/.- --------------------------- By: -------- -- --------------------------------------( aid/or Contractor) , P A&- By:--•------------- ---------------------------------------- --------------- (Plot plan, showing size of lot,.-location of system in reD4ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- •_ r�r--�-ta ----------------------- DATE--��---- - - / --------------------- ------------- - REVIEWEDBY--------•--------------------------------------------------------------------------------------------------------------------- DATE--------------------___----------------------------------- BUILDINGPERMIT ISSUED--------------- ---------------------------------------------------------------------------------:... DATE-------------------------------------------------------- Alterations and/or recommendations=:------------------ ----.f-_� ---------------------------- -------- ----- -- •--- ------------------ -- ------ -�---------------------------•- -•-------------- - -------------------------------------------- -------- -------- ------------- . ----------------------------------------- --------------------------- ------ --------.-- ---------- ----------- -------------------------------------- --- Da', Cl FINAL INSPECTION $Y:. 47 \..�... _ rte Date �� ----------------------- SAN z V-,�/--- -------- --------------------- �I SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E5.9 HEV+9ED 8.59 F.F.P0.2M 6.60