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FOR OFFICE USE: --�_---- ----------- -------- --- APPLICATION FOR SANITATION PERMIT - Permit No. ---/�-��-�/�-•-- ----------------------- - ' /G M ' ` 4 ___ (Complete in Duplicate) pate Iss ed X_ 15s- -0--- ----------- --- - --------- --- This Permit Expires 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 ii made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCAT ON____ - -------- - Owner's Name--- -- - _ U .E Phone S� f?4 Address--------------- -•-- Cr-- -------------- --- -------------------- f ------------------ Contractor's Name-------------- --------- - Installation will serve: Residence Apartment House ❑ Commercial .❑ Trailer Court ❑ Mo#e j Other ❑ Number of living units: ---Z--- Number of bedrooms _ __- Number of baths ---L_ Lot size __._-�- ---- Water Supply: Public:system ❑ Community system ❑ Private �Igepth to Water Table --- 6'e9 ft. Hardpan ❑ Character of soil to a depth of 3 fee#: Sand Eli Gravel F-1SandyLoam❑ Clay Loam El—Clay ❑ Adobe ❑ Previous Application Made: (If yes date.___.__- 1 No [ New Construction: Yes ❑ Na [ /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-_-__.._--_____Distance from foundation------------------- El ._________________ ❑ No. of compartments ------ ---Size--•----------------- ---- ----Liquid depth_ -----------------------_._._...-.._._ C_.-a_ a._ci _t_y__-_-_-.-.-_-__-_-_-_-_-_--_--_-.-_----•.--'- � Disposal Field: Distance from nearest well__6_&.!f Distance from foundation_-/4"r/�5_--"-'/ .Distance to nearest lot line_ _-5'___ � Number of lines----------- -- --------------Length of each line----- L�-l}--- T---Width of trench----- ----------- ---------- Number of filter material__ t �A /t�_-Depth of filter material___l9-`�-- ----Total length___.--!-042-- j---- QQ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_________________ ❑ Number of pits---------------------Lining material-----------------------Size: Diameter.----------------------Depth-- ---------------------------._. I Cesspool: Distance from nearest well-----------------Distance from foundation------------------_Lining material------------------------------------- t♦/1 Depth Liquid Capacity Privy: El Size: Diameter----------------------------------- p Privy: Distance from nearest well___________________________________________ Distance from nearest building____._-________._______-_____..___..___-. ❑ Distance to nearest lot line`-----:-----r;----------- ------- ------------ ---------------------------------- ------------- -- ---------- Remodeling and/or repairing (describe:----- ------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------------------- ��-- --�-Q----- X1-5 �N ----- E- / f ---------- _=--------------------------------------------- -_._ . - - ________ ___ _ __ _ ____ _____ ____j----_ __-_ ____-______-__--_--_______ ____________-_____.______________-'._____-_______--____-_____-_-______---___ ______-________---____._________-_.-_--------------- . I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State 1 rules and regulations of.the-San Joaquin Local Health District. �� -�. -....... ----------- --------------------------------------- -- -- wn r and/or Contractor) [Signed}.------------- - �----� ' 1 By--------------- .�P. �---------------- (Title)---- f --- --------------- ---------------------- ---- (Plot plan, showing size of lot, locat' n of system in-relation to wells, buildings,-etc:;can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------•- --------------- - DATE'-- '� l ---- DATE------------------------------------------------------ ----- BUILDINGPERMIT ISSUED------------------- ------------- ------------------------------- DATE-------------------------- --------------------------------- -------------- ----------------- ------------ Alterations and/or regqommenda#ions------- --------------------------- ---- ---------------------------------------' = ---- ail -- 3S '! �� _ met � ---- +, , ` L r _ ew ed -------- ---- FINAL INSPECTION BY:------------- -------------------------- -------- -- ------- Date-- ------------------- ---------• ------- - ----- -- ------------------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT t 1601 E.Hazelton Ave. 3oo West Oak Street 124 Sycamore Street 205 West 9th Street I Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.