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FOR OFFICE USE: ----- ---------- -- Q- j APPLICATION FOR SANITATION PERMIT Permit No. ..0 .z .... � -------------------------------- -- - (Complete in Duplicate) Date Issued ----------------------------- --------------------------- This Permit Expires 1 Year From Date Issued i 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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATIO _...- .. 0 6 !`. �_G__ ..:. �� Owner's Name- .l�--C'---- a��4--••----------------------- -- -- Phona-----•------------------------------ Address------ ----------------------•- -- Address----•- l -------------•----•--------------------------•---•-----•-----.. --------------------- ----- -----------------------_-------------.................................................. Contractor's Name - •------- -`S T S -----•- ---------------- Phone----- -----------.-_-. Installation will serve: Residence [�Aparfinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [❑ Number of living units: __L____ Number of bedrooms _j_____ Number of baths -/----- Lot size .6- +est-_________________--.--_-___----_____ Water Supply: Public.system ❑ Community system ❑ Private t]repth to Water Table .G-rlft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe'al--Flardpan ❑ i Previous Application Made: (If yes,date.-------------------) No V!f— New Construction: Yes [R0-`No ❑ FHA/VA: Yes ❑ No �r 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___�.t"__0_` ----Distance from foundation----/�'._-______.Material__�t ______ _-_-__ . ------ i No. of compartments---A.------------------Size._`_3 47x_'�k.........Liquid depth------$_ --------------_Capacity.4r-O Disposal Field: Distance from nearest well.4-P........Distance from foundation____ _--____._..Distance to nearest lot line-5----- ©� Number ofr lines--- ----------------------- -----Length of each line-- 4-"---- Width of trench-- - ------- ------------ Type offilter material-7o�.-------_Dept of filter material__/B:_'_____._.__.Total length-----&'U_ ____________________-_--__. Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance to nearest lot line--_---_____-__ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth_..._____..________.____---_-.-_ la l Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material_____------._-------------__________ I ❑ 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 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 an re ulations f the San Joaquin Local Health District. (Signed) .__.Owner and/or Contractor By:-----------------------------------------------------t------------------------------------ ------------------------------------------(Title)-------------------------------- ------ ......... ---- ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc.,,can be placed on reverse side). t R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- -- ----- ----- ---- ------------------------------------------ DATE-------- ----------- ----------------- REVIEWEDBY------- ----------------------------- --- -- - --- --- --------'-----------------------------------------._ DATE----------------------------------------------------------- BUILDING PERMIT ISSUED —------------------------------------- bATE ---- -------------------------- Alterations and/or recommendations:----------------- - --------- ---- ---------- - -------------------------------------------------------------------------------•-------------------- --------_ -------------------------------------------------------------------------------------------------- ---------------------------------------------------------------•---------------------------•-------------------•-•-------- -------•-------- -•----- ------------------------------- ---------• ----------------------------------•------------------•-•----------------------------------------------------------- ------ ----------------------------------------------------------------------------------------------------------------------------------------------------------=------------------------------------------------------------------- FINAL INSPECTION BY:...----- ------- - -- --- -- --- Date------e�- // ^{3 --------------------- ---------- ------------- SAN Q -JOA UIN LOCAL HEALTH DISTRICT 1601 E.Masellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P:CO.