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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. - ---- ------------------------------------------------ .��?A..�.._... ---------------------- ''- (Complete in Duplicate) --- ------------------ 0 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. H o r— > JOB ADDRESS AND O TION____- -g _____ ___ � -------�CCN12 --OF— Owner's Name---- --------- ------- � - g € � Phone------------------------------------ ------ �L� Address---- --Pi-Tv---- /---—------ -o-K--------t>0.6 ----------- V-S------------------------------------------------------------------ Contractor's Name----------0-W-N-TR---- ------------------------------------------- ------------ ----------------------------------------- Phone---------------------------------- Installation will serve: Residence F---Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----� Number of bedrooms __" _ Number of baths I_._ Lot size ----- X___1_5_ �_____--_-________._ Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table -___ --- ft. Character of soil to a depth of 3 feet: Sand U'Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 13" New Construction: Yes 21--M-6 ❑ FHA/VA: Yes ❑ No 2-- 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____________-_____-_______-_____-____--_--. �;(3's;r/1� ,_ No. of compartments--------------------------Size- _____---_-_ -_ _ Liquid cle-gpth-------------- _--__-____ Capacity______ ____ ______ Disposal Field: Distance from nearest well �C-_�tv Distance from foundation.... —0 ___.Distance to nearest lot line .___.. Number of lines------------ __-------------------Length of each line-------3 --------______-Width of trench.---_3 Type of filter material_-- -G�_ ._Depth of filter material___-- ----------Total length______--_-;,af3___________________. Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line___________._____ ❑ Number of pits----------------------Lining material---------_------------Size: Diameter--------------_--------Depth-----------------------.__.-..- H 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 -------------------------Remodeling and/or repairing (describe):------------------ ---------•------------------------------------------------------------------ ------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ---- ---- I hereby cert'.fy,,that I have pre qed this application and that the work will be done in accordance with San Joaquin County ordinances, Stat I s, and rules an �regulat. 0f the San Joaquin Local Health District. l� SignedfiA / _.__-Owner and/or Contractor By:--------------------------------------------------- ----------------- ------------------ ------------------------(Title)--------- ------------- -- ----------- - ---- --------- (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 �� /� z APPLICATION - APPLICATION ACCEPTED BY----- _.1 fs.l `=------------------------------- -------------------------------------- DATE--------- V------------- REVIEWED BY------- ------------------- --------------------------------------------------------------------------------- ----------- DATE------ --------- ---------------------- -------------------... BUILDINGPERMIT ISSUED--------------------------------------------------------------- ------------------------------- ----- DATE------------------------------------------------------------- Alterationsand/or recommendations:---------------------- ------ ---------------------------------------- ----------------------------------------------•-------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------•------ --------------------------------------------------------------- ------------------•------------ ----------------------------------------------- ----------------------------------- -------- Date. ------- f FINAL INSPEC `r� r�1 ! r �/� Date.----- ------ / `! -- 1 -------------- ------------ 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 F.P.CC.