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FOR OFFICE USE: ------------------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ji jam ._... ----------------------------- ------------------------ (Complete in Duplicate) --( �=-(,S _____________________ 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. S49 ,F Y JOB ADDRESS AND LOC TION ---- - ( :. Owner's Name._ ----- ---- ------ Phon _____. ' 1' Address---- -- -- --•------ -------•--- ------ --- -------------------------------------------------------•--•------•-------------_.--------------------------*- --- --- --------••- Contractor's Name----- ��t5� .' -------------------------------------' Phone. Ii ---------- ---- t ---------- Installation will serve: Residence ®�artment House ❑ Commercial ❑ Trailer Court ❑ Motel�❑ Other ❑ Jl Number of living units: __ Number of bedrooms -- Number of baths _ Lot size _y � Aev-A___ ____ ____________ Water Supply: Public system ❑ Community system ❑ Private 0 ( epth to Water Table tt. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [,f lay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-----------_--------) No 52---INew Construction: Yes g?"I'lo ❑ FHA/VA: Yes � No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) A y '1 Septic Ta k: Distance from nearest well----&-_____Distance fram�f undation_./$(_._._._..Material--- _ _l ,n4' ______..._. [[� No. of compartments_�--- ---------l.-Size,,rlXg7�X_ Liquid depth____!Distance from foundation__ //____.______Capacity/� `.---- __ Disposal Field: Distance from nearest well.. --------- __f----- Distance to nearest lot line .... Number of lines----- - g ! r - Length of each line ��.._____ ____.Width of trench-_�____________________________ j___Distance frl m foundation___ /___.Distance to nearest lot lin �� i i Seepage Pit: Disa oef tloenearest ate iwelL-well.-Ile cath of filter matenal__,f �� Total length -11, _ __�� Number of pits.__.------------Lining material___ .__-Size: Diiaarneter__-�--_..___Depth_ Cesspool: - Distance from nearest well-________________Distance from foundation--------------------Lining material- ------------------------------ C I Size: Diameter---,---_---__----- :-- r -Depth Liquid Capacity -gals. ----------------------Distance from nearest building -Y - i � _ ❑ p qr � P Privy: Distance from nearest well------'----__-'.- -- g----------------------------='-------- - Ali ❑ s Distance to nearest lot line- - ` -1 ------------ -------------- Remodeling ----------- Remodelin9 and/or repairing (describe):_. _)i ._ ------------- li s 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 r es and regulations of +he San Joaquin Local Health District. `r . or Con (Signed)----- - -- - ----- '- ----'------- - '-- - ---- '-'--- - -- ----- ---'----- ---- ---- - - --{� tractor} sY' -------------•------------------------------ -------(Title)- �`� r (Plot pian, showing size of lot, lova+ion:of system ' elation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 'REVIAPPLICATIONACCEPTED BY-------'r i --------------------------•--------------------------------------------------- DATE------------------------- -------------------:�------------ REVIEWED-BY----------------------------------- EWED,.BY----------------------------------- - -------- ---- -------------- ------------- ----------------- ------ DATE------------ ----------------------------------,----•- ' BUILDING PERMIT ISSUED----- --------------------------- --------------------- --------------------------------------------- DATE-----------------------------------------------r Alterations-and/6'r - -- -recommendations:- - ---- -------------------------------- ' ----•-----------------------------------------•------------------------------------------ � , .. _ it -=------------------------------------------------------------------------- - ----- ----------------'----------------------•--------------'------ -------------=------=--------- f R -------------------------------------------------------•-------------------------- - ----------------------------------------------------------------------•------------------------------------------- ----------- ............. ................ --- ------------------------ -_._..__.-_...______..________._..___..__.._____.____.________f_..._._._.._ I .. # FINAL INSPECTION BY-------------- -----• ---- -- - 46 Date... -=X.......... -- - - ------- -------- -------------- 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 it �