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APPLICATION FOR SANITATION PERMIT Permit No. ..11l r� <br /> (Complete in Duplicate) Date Issued !}&Z2FY_ <br /> Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. <br /> This application is made in compliance with County Ordinance No. 549. <br /> JOB ADDRESS AND L CATION--y =31 s---------- `---------------------------.--------.......- ..-........................................- _............ <br /> - - <br /> � <br /> Owner's Name -l� r..LL�� �..........-._._.... ...--..... ------ -- ...._.. - ....-.... Phone.... - - _J... <br /> Address..............._..T-glY-... �>t ------- -------------r ...--•-•-......-........ y� <br /> Contractor's Name.----- - LYS! ... 403". <br /> .. (1.✓rti1C:... !-'-`a'-..=--'---...--------------•----------------- Phone_- r .-----•--•-'----- <br /> Installation will serve: Residence (A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ <br /> Number of living units: ---1.. Number of bedrooms A-_ Number of baths ..A-... Lot size _:�kAp . <br /> Water Supply: Public system 54 Community system ❑ Private ❑ Depth to Water Table JfAX ft. <br /> Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe® Hardpan ❑ <br /> Previous Application Made: Yes ❑ No [Z New Construction: Yes go No ❑ FHA/VAI Yes ❑ No JK <br /> TYPE OF INSTALLATION AND SPECIFICATIONS: <br /> (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) <br /> Septic Tank: Distance from nearest well.................Distance from foundation..._...............Material................................................. <br /> ❑ No. of compertments........._.............Size--------------..................Liquid depth....................------Capacity...................... <br /> Disposal Field: Distance from nearest well.................Distance from foundation....................Distance to nearest lot line................. <br /> ❑ Number of lines._............._....._..........Length of each line---------------------_......Width of +ranch.................................. <br /> Type of filter material.........................Depth of filter material.......................Total length.................................0-....... <br /> r <br /> Seepage Pit: Distance to nearest well-es . ..........Distance from foundation-./A..............Distance to nearest lot line......... <br /> _.... <br /> Number of pits...................Lining material...T.9Q.4--------Size: Diameter...-�9.p--------_Depth-----J�................. <br /> Cesspool: Distance from nearest well-................Distance from foundation....................Lining material..................................... <br /> ❑ Size: Diameter_...................-:..........-Depth......................._---..........------------.Liquid Capacity-----------------------_-.gals. <br /> Privy: Distance from nearest well...................----------.-------............Distance from nearest building.......---................................ <br /> ❑ Distance to nearest lot line------------------------- --------.....-------............_....-...........----..............._.................-----•----- <br /> Remodelingand/or repairing (describe):.........-.............................................._----------_...............................-..................................._.... <br /> ----------------------------------------------------------------------------------------—­.........................................­­..........................-..........-................--....... <br /> .---...-------------_.............-.................................................................-_..._-.................-..-._.....-•-------------------- .......... ..................------- <br /> I hereby certify that I have prepared this application and fhaf the work will be done in accordance with San Joaquin County <br /> ordinances, State laws, and rules and regulations of the San Joaquin Local Health Disfrict. <br /> Contractor) <br /> (Signed-------------------------------... ........................ ..... ........................................ - - (Owner and/or <br /> By:..... - --- -- - ......... .. ... (Title)----------- - .......................................... <br /> - -- - - <br /> (Plot plan, showing size of lot, locafio f system in relation to wells, buildings, efc., can be placed on reverse side). <br /> FOR DEPARTMENT USE ONLY <br /> APPLICATION ACCEPTED BY....l.�.. ...-() - . DATE - <br /> REVIEWEDBY..................................................--•-----.............------............._..........------............. DATE............................_-...—...------------ <br /> BUILDINGPERMIT ISSUED.................................--•-............................-......................-....... DATE-------____...............-.................... <br /> Alterationsand/or recommendations:............--------...........................-......_...........-.......................-.....................................-............ <br /> -•- •-.... --------------- <br /> - - - - - <br /> t----sd s�1---- r- "- - --. _...... .....-------- --- - --------- <br /> .................._....-----•------- <br /> .......-............................---..................__.................. ---...........-......._-...........- - <br /> r i ' <br /> -------.-........------.. <br /> FINAL INSPECTION BY ......._ • .......... - ................ Date....- --..... <br /> SAN .. <br /> JOAQUIN LOCAL HEALTH DISTRICT <br /> 130 South American Street 300 Wart Oak Street 132 Sycamore Street 814 North •'C" Street <br /> Stockton, California Lodi, California Manteca, California Tracy, California <br />