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.....•........................I.___....._.._.............. APPLICATION FOR SANITATION PERMIT Permit No. ......................................................... (Complete in Duplicate) ............................................... .......... 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 a lication,is made,in,compliance with County Ordinance No. 549. pl-r_ 090. .5/ JOB ADDRESS AND OCAT ON.:. `1ZA115.- ............ -...... ...................... .._ a. Owner's Na l . -•---------...•.. --------------------------•....._...... .. --- . .....----•.............. .... .. . ......� .---•-•----... ......_. Phone............................._.._...'� Address---•-- at- `f'.�1... ---- - ----------- ----............ ------ ------------------=------------------ Contractor's Name........... •✓ --- - -------••---•---•---------• Phone...........:....................... ^(; Installation will serve: Residence ❑ Apartment House ❑ Commercial ! Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ .. :Number of bedrooms . -!=. Number of baths Y._ Lot size ....................... i ------------------------------- Public --•------------------------ Water Supply; Public system ❑ Community system [J Private �epth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: llf yes,ldate.....................I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No eptic-bink or cesspool permitted if public sewer is available within.200 feet.) r. V Septic Tank: Distance from nearest well----------------Distance from foundation-_--.--.-_--_.-..._.Material................ _..._. ❑ No. of compartments---..... r ............. Size Liquid dept .........................Capacity.-.................... D;spo a acity.......................DispoField: Distance from neare_st wtsll::?�4s!t_.i Distance_ ,from foundation.....1A.'_...Distance to nearest lot line.._s'._..__-- Number of lines__.._`..___!.- -`- ---------LengthJ of each line _-- ,-rj,ta_'________ ______Width of trench...... Type of filter material_....._SA�_.....�Depth bf filter material.......Lf.-...........Total length........ii';.................. Seepag I : Distance to neargst well.... °�•�--('...Distance from foundation_:-_LP--.'.__...:_Dis��4e to nearest lot fire....f.�..._.. Number of pits._. .0-_-_._._-._Lining materlal...___J$.Jz ...___Size: Diameter:- ,3.,,-_:_--Depth__.... i...__..._.. .. ` •X ".y I c . t Cesspool: Distance from nearest well..... _....::Distance from found+ion....................L-ining material................... ❑ Size: Diameter-- ----:......----Depth.----- ` ...............................Liquid... Capacity-------------_--- -gals. Privy: Distance from nearest well------>_________________•,------- �.-Distance from nearest 6uildin --•---. g......... ----•------------ Distance to nearest lot line......................:•f....__..--.._.__. Remodeling and/or repairing (describe):..__ •� '_-- __ 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 rules and. regulations of the San Joaquin Local Health District. (Signed). •--•-klon_i, ---•---•------ -------------------• ------------- --- __- and/or Contractor By:------- - --- --- ------------ ------ •-• --_--------- --- -----------------------------------------...Title { ) ......................... ...............•-•--- (Plot pian, showing size of lot, location of sys min rewells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.Z .- r ,`,%l. -_•--_ ._---=--•..-----•-- DATE_.-.-3-`.�-- •-��....�---------------•--.. REVIEWED BY......................................... .------------•----•-----•.._................-•---....---•......---............... DATE BUILDING PERMIT ISSUED...-•---------•................................ DANE._...---------•----• Alterations end/or recommendations.......... �. ................................................................................. ----•--- ..................•----•--- ------------•---•- --•.............•..._-.........................................- • • -----.... %_ ............................... . .......................................................... -------•. ........................................................--•.......................................................................... ---..............................................................................__......_.. FINAL INSPECTION-BY:.,�_ ......,. ------ Date .^.7..'G................. SAN JOAQUIN LOCAL HEALTH DISTRICT - - f 1601 !.Moulton Ave. t 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Co. t e ,