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FOR OFFICE USE: - - -- ----------------- -------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._a_ ............. -------- -- ------------------ --- -------------- -- ----------- - - s (Compeuplicete) Date Issued------- ------------------ ---------- Expires This Permit 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 complianc'e wit o ty Ordinance No. 549. JOB ADDRESS AND OCATION------ .- Owner's Name---- f�-','Vey-. ��' Phone/ - - --------------------------------- 7' -� __ --- _ Address-------•=�------------------------- - il �y� ------------•----- Contractor's Name � ` Phone---•------------•----------•------ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/ or A Number of bedrooms _� Number of baths __f._ Lot size _ � Water Supply: Public system 911Communify system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: . Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E]"Rardpan ❑ Previous Application Made: (If yes,date............--------) No [t' New Construction: Yes ❑ No [9—`FHA/VA: Yes ❑ No jg- TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public-sewer is available within 200 feet.) Septic Tank.: Distance from nearest well_________________Distance from foundation-------------------Material...... _ �i�, No. of compartments--------------------------Size----_------------------- ----Liquid depth--------------------- ----Capacity --------- --------- Disposal Field: Distance from,nearest.wel----------- (Number .______, Distance from foundation--------------------Distance to nearest lot line._--___._______ (Number of lines--I-------------------- ------------Length of each I'me---------------- ----------- Width of french s - �� Type"of filter material-------------------------Depth of filter material-----------------------Totalwo length------- ----------•------- --- ----- J Seepage Pi .Distance to nearest well-'" _______________Distance from foundation___-/Q"_.___.Distance to nearest lot Im __ Number of pits__,�__ --------------Lining material_-P,o-cr�---- Size: Diameter-- . _��...___Deptl-3.S'-,� N Cesspool: Distance from nearest well-----------------Distance from foundation_ ________-.Lining material__________________ r ❑ Size: Diameter--------------------- ----------------De Depth p - - - --- -- -----Liquid Capacity----- --------------------gals. Privy: . Distance from nearest well__________________________________---------------Distance from nearest building_ __ 9 ❑ , Distance to nearest lot fine----------------------------- Remodeling and/or repairing (clescr;be):-------.----------- ----------- --••------------ ------------ ----- --------- -------- --- - - -----------------------n---------- -;Z/- ------------------- ---'-------------------------- ----- - --------------- ---- --- ----- -- - •------------------•--------- ------------------------------------------------- �''� I;hereby certify that I have prepared this application and that the work will be done in ccordanc& witF-Sa?Joaquin County 1 ordina;ces, State laws, and rules and: regulations of the San Joaquin Local Health District. Si ned.� ______________(Owner and/or Contractor) , BrF `�-� -= ----- ----------------- (Plot plan,, snowing size of lot, tion of system in relation tells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE NLY APPLICATION ACCEPTED BY------------- 'J--------------------------- ---------------------------------------- DATE---- JJ' ` -- ------ REVIEWED BY----- - DATE_ - --------------------- ----- ---------------------------•-- BUILDING PtRMIT ISSUED-------------------------- DATE. .--------------_-- - Alterations and/orrecommendati - --- --- --- - ans:_.____ S -----•------------ - ._ i - - ------------------------------------------------------------- ----------------------- --•-------------------- I ------------------------------------------- ---- -------------- - ------------- ----- - ---------- FINAL INSPECTION BY:....___.._. _. _ - Date ✓7 = --- !- ----------- ----------------------- - °� m,R SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave.' t' X300 West Oak Sheet . a 124 SycorP Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 'r f F.P.C Q. + i