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FOR OFFICE USE~ ----------------------------- - ------ -------- --------- _______________ _ APPLICATION FOR SANITATION PERMIT Permit No. . ------- ------- Y -- -------- ------------ (Complete in Duplicate) Date Issued ----------------------------------------------- --------- This Permit Expires 1 Year From 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. / M'T-r-6 JOB ADDRESS AND L0 ATIONN_ - _-. _A-------- . _�-� _---- .---------3.3-5--------J......A.Lt9N__I__F_D_1�}.__,_ Owner's Name----- ...... ---------------•-------------------------------------------------------------•-------------- Phone.................................... 3 Address............. q--- ---- ---------M = --------------------------------•----•---------•------•-----•---•--•--------------•- Contractor's Name- 5 7 ------------------------- ----------- Phone................................... Installation will serve: Residence [!I- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms J-- Number of baths -1----- Lot size __--- �------------------------------------ Water Supply: Public system'ErCommunity system ❑ Private ❑ Depth to Water Table 1.2--ft. Character of soil to a depth of 3 feet: Sand tr Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [J�New Construction: Yes ❑ No- FHA/VA: Yes ❑ No JQ— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi nk: T" -Distance from nearest well-_______________Distance from foundation.------------------.Material------------------------------------------------- No. of compartments--------------------------Size.-------------------------------Liquid depth--------------------------Capacity----------------------- Disposal ------Disposal Fie :/ Distance from nearest well-_ _..-_Distance from foundation..!_�..�____._..___Distance to nearest lot line__s------------ Number of lines----f-----------------------------Length of each line----7.6=.!_________._.Width of trench___-2,_4-----------._.---_-.__._ Type of filter material__.-_[_AC:-.__Depth of filter material--_/_g __'.........Total length--------76-------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--.-------....... ❑ Number of pits----------------------Lining material-----------------------Size: Diameter_--------------------Depth------_-----_-___--.-...._-_--_ 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):----- '-------OF-----eq-2/----.:5�=__VV_ =---------------------•---------•--•--------•--- ----------------------------------------------------------•-------------------------------------------------------------------------------------- -------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------- --------------- ---------------------•--------------------------- ------------------------- ----------------------------------------------------------------------------------••---------------------------------------------••---------------------------------------------------------- - I hereby certify that I have repared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ru and regulations the San Joaquin Local Health District. X Si ned Zof ------------ - - -- ---- ---- ---- ---------------------------------- Owner and/or Contractor (Signed) G ( / 1 By:------------- ------------------------ ------------ --------------------------------------------(Title)---------------------------------------- - ---- --------- (Plot plan, showincation of systemin relation to wells, buildings, etc., can be placed on reverse side). p FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------�._!.-R--Q------------------------------------------------------------------- DATE----- f - - '-�-- • - ---- ----------------- REVIEWEDBY-------------------------------------------------------------_------------------------------------------------------------- DATE------ ----------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------- ----------------------------------- --------------- Alterations and/or recommendations:--------- -----------------------------------_---------------------------------------------------------------------------------------------- --------------- ------------- ------ ------------------- ------------------------------------------------------------- ---------------------------------------------------------------------------------------------------_--------------- ---------------------------------------------------------------------- __---------------- -------------------------------------------------------------------------------------------------------------------------- X- Z6 FINAL INSPEC _ Date__.________.__ ... -4W_ 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.F.0 C.