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FOR OFFICE USE: ------------- -- -------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .a..L_f A�Z --------------------------------------------------------- (Complete in Duplicate) ___________________ This Permit Expires 1 Year From Date Issued W pate 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. „ w JOB ADDRESS AND LOCATION- 2. _-_.Z ="- ----------✓-- ---`'- ----------------------- Owner's Name = �� .!�� Phone ------------ Address ._.1. f --------------------••------------------•-•----------- ----•-------------------------------------------------......... .. Contractor's Name-----Z ------------------------------• ------------------------------------------------------------- -------- ---------------- Phone----------------------------------- Installation will serve: Residence © Apartment House ❑ Commercial ❑ Tra//iler Court ❑ Motel E3 Other ❑ Number of living units: /------ Number of bedrooms __�_ Number of baths 1______ Lot size _________________________________________ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table _?_C7_ ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ED Clay [] Adobe ❑ Hardpan-8 Previous Application Made: (If yes,date -------------------) No ❑ 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.) Septic Tank: Distance from nearest well-----------------Distance from foundation------------------ Material------.---------------_----------------_--___ ❑ No. of compartments--------------------- --Size--------------------------- ---Liquid-depth----------------- --------Capacity----------------------- Disposal Field: Distance from nearest well. Distance from foundation_- 19--------Distance to nearest lot line--;E -_--__ ] Number of lines...... ___________________________Length of each line---1,I__-?_---------------Width of trench: .q-------------------------- Type of filter materialAlf--------------Depth of filter material-----Z_?-_- length--- _�______________________-__ Seepage Pit: Distance to nearest welO�_-_________Distance from foundation-_��.-__-_____.Distance to nearest lot line_____}_ -------- Number of pits--__�_____________Lining; material_-1_--------Size: Diameter---3_---_l�____--___Dept -'_-______------______ Cesspool- Distance from nearest well-----_--------___Distance from.foundation--------------------Lining material-------------------------------------- ❑ Size: Diameter-------------------------------------'Depth--- -- ------------!-------- ---- ------- -------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------_---- --------------- '_--___fes--_Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line t '- -------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):---l � 't _ {^-_____..... -------_7 -- --- ____________________________________________ �F 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.xegulatjons of the San Joaquin Local Health District. - - t -(Signed)-C;, -- - s r ------------------------ - - -(Owner and/or Contractor) By:--------------------------------------------------------_1- --------------------------------------------------------------(Title)------------ ---- ---------- -------------------- --------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). R r � FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY_.- fes= r1-_-�c_ ------- -- ----------------------------------- DATE----/-�9— '7 ------------------ - - -- - - ------------- ---------------- BY---------X- ---------------------------------------------------I---------------------------------------- ----------- ----- DATE--------- ------------------------------------ BUILDING PERMIT IS SUED DATE--------------------------------- --------------------------- Alterationsand/or recommendations------------------------------------- ---------------------•-------------------------------------------------------------------•---•--------------------------- --------------------------------------------------------------•---------------------------------------------------------------------------•------ ------------- ------------------------------------------------------------ -----•--------- ------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- xll FINAL INSPECTION BY:. a :-.,,-<t - Date--/—..-7 e7 - ----------- ------ -------- SAN 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 �.e.co.