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FOR OFFICE USE: . ----------------------------------- o._ --------- APPLICATION FOR SANITATION PERMIT Permit No. Pa. ... / ------------- ------ (Complete in Duplicate) Date Issued_=� y- ------------------------------------------___________..._ This Permit Expires 7 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 co pliance with County Ordinance No. 549. 22 e— of --i i,pON DO3 S. x"74 c� 771,E e W. ti 1 JOB ADDRESS AND L N. i-r�7al� ATIOS'oc�7l ± ---------------- W- N Owner's Name ----------- N{ 1(�}_ - ��R.Q - -- --- Phone------------------------------------ Address------------------ �..-- ---- -R_0_X---------------L/-11�2------------------- ------- -•----•-•--------------------------------------------•-----------------------•-•- Contractor's Name------ _� f_LLQ-------------------------------------- . ---- Phone----....----------------••--------- Lgv"i is---;S}jF p--------�01�KS-Ho p�----- Installation will serve: Residence ❑ Apartment House ❑ Commercial �ailer Court ❑ nMotel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size ____ ___________________ Water Supply: Public system ❑ Community system ❑ Private:❑ Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand Z---'Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made-%(If yes,date____________________) No 0--lNew Construction: Yes 5?"*No ❑ FHA/VA: Yes ❑ No [� TYPE-OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well---SP___Distance froLm foundation___19----------Mate ial.__REDwO04t)-_--..__ _xS_Li uid de th___`f -________Capacity_...&__-- C----- No. of compartments [Z}� --------------------------Size______x_ q p O Disposal Field: Distance?from nearest well- __-_Distance from foundation---/Q---------Distance to nearest lot line___57..... a Number of"lines-----------/--------_------------Length of each line-------- Q_._°_----__.Width of trench._--- `---------7--_-- 8 Type of filter material. _ _fa_ / ___Depth of filter material-------20-_-_--_Total length--- ------------------- Seepage ength_________________Seepage Pit: Distance to nearest well_____ -------------- from foundation------------------- Distance to nearest lot line---------_.______ ❑ Number of pits-_------------------Lining material-----------------------Size: Diameter--------------.---.___-Depth------.__.----------------------- Cesspool: Distance from nearest wel!-----------------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)----------------------------- -------------------------------------------------------------------------------------------------------------•------------- ---------•---••------------------------------------------------------------------------------------•----•------•---•----------------•--•----•-----------------------I--------------------------- ---------------------- 1 - -- - ---- ------- -------------------------------------------- ------------------------------------------------------------------------------------------------ --- ------- ------ - 1 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 /rulland regulatio s of the San Joaquin Local Health District. (Signed) f� (Owner and/or Contractor) -------- _--�- By: --------- ---------;-------------------------------------------- Ti+le --------------- (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 APPLICATION ACCEPTED BY----------�i_R_0'- ----- -------------__---------------------------------------- DATE--------- REVIEWEDBY-------------------------------------------------------------------- ------- ------------------------------------------------ DATE-----------------------------------------------------------. BUILDINGPERMIT ISSUED-------------- ----------------------------- ---- ------------------------------ ------------- DATE-------- --------------------j---------------------------- Alterations and/or recommendations------------------------------------------------------------------------ -------------------------------.-----------------•-•------------------•---------- � - � a ---------------------------------------- ------------------------------------------------------------------------------------------------------------------------•------------------------------------------------------- -----•----------- ---------- ---------- -----•------------- - - ------------- i FINAL INSPECT -- Date--------------------- _----- ----------------- I b. SAN JOAQUIN LOCAL HEALTH DISTRICT U 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California