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FOR OFFICE USE: ------ -------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -- -- ------- ---------------------- ----------- - (Complete in Duplicate) Date` // ------------ --- This Permit Ex ires 1 Year From Date Issued Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. t This application is made in compliance with County Ordinance No. 549. 013 —t 2-0 .._2-0 JOB ADDRESS AND LOCATION-41^ x�_ ---- -------- -- .. G•-� 1 Owner's Name----- ----•-------- -a- ----- - - ----- .. Phone------------------------------------ -------------- - ----------------------- - - - - Address----,40,___o!_---��1j?,l------- L d �_ 1 Contractor's Name._c � -------- ------------------------------------ !e 3 --FY'S ------------------ Phone... -�- - -- -- Y Installation will serve: Residence [A- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/---- Number of bedrooms -3---- Number of baths -.ice._ Lot size -----�qe-0_:?",F---------------------------------- Water Supply: Public system ❑ Community system ❑ Private [�- Depth to Water Table -7A'ft. Character of soil to a depth of 3 feet: Sand V�? Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ ^Hardpan ❑w _, ; w.. - _. - •� - - -� evious Application Made: (if yes,date---_'_".T_ }' No 93- New Construction: Yes ❑ No [?3- FHA/VA: Yes ❑ No R} TYPE OF INSTALLATION AND SPECIFICATIONS: �p (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept�Tank: Distance from nearesr well___,'" ...._Distance from foundation...../_Q......_.MateriaL_G-d ............. No. of compartments------- -----------....Size--3_.- --re_ - __--Liquid d � e th----_ .- ------------Capacity----�uQ ispoos I Field: Distance from nearest well___X_b ---Distance from foundation--�Q.�..._.._.Distance to nearest Iodine-4--_�-----+ _ Number of lines---------1-----------------------Length of each line-------`.-------------------Width of trench----- .____---------------------- Type of filter ii v matenal____�o_G.G(_____Depth of filter material_._../_�_______.__.Total length---- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-------.--___-_-- NF-1ts-------------- Size: Diameter---------------------. _------ --- --- Depth_ II umber of pi ..__..__Lining material----------------------. p - - -_--_ Cesspool: Distance from nearest well-----------------Distance from foundafiion--------------------Lining material __...________________ ------------- ❑ Size: Diameter------ ---- ------ -------------------Depth-------------------------------------------------. Liquid Capacity----------------------------gals. Privy: Distance from nearest well__._.__ ---------__-----_-__----_--- ---__-Distance from nearest building-___. --------------------------- Distance to nearest fot line._.___.________________________ __________ _ madeiing an /or repairing (d scribe): ---- - ------ -------------------------- ----------------------------I ..� ._._--------------------�---------------- -------------------------------- - ------------------------ -------------- ----------------------------------------------------- ----------- I ------------- ------------------------------------------------ ' '� -A----- — - u�. ---------------- j i I hereby certify that I have prepared this application and at the work wl I b done In accordance with,San Joaquin County ordinances. State laws, and rules and regulations of the San Joaquin Local Health District. =--.-- ------ ---------------- (Owner and/or Contractor)i_ ---------- 8 (Title)_ O-c-tA*-�- ` (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 '` PPLICATION ACCEPTED BY -- - -------------- DATE----� ----af ------------ REVIEWEDBY----------------------------------------- --- ---.------------------------ DATE -------------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------------------------------------------- - DATE-- ------ -----------------' Alterations and/or recommend 'ons:__.__ __ =_ -- ------- ----------- -------- ----------------------------------- --------- ------------- --------------------- ------ ------------- ------------------------- ------------------------------- -------------------------------------------------------------------------------------------------------•------- - ------------------- --------------- ---------- ---------------------------------------------- --------------- ----------------------------------------------------------------------------------------------------------- ------ ------------ ------- -- ------ ------------------------- --------------------------------------- ------- ----------------------------="---------------------------- n F1NAL INSPECTION BY:.. -------------------- Date .-- - `-- -- ------------------------------- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.RZO.