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r OR OFFICE USE: - ---- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. _f /-6 - j�-7------------------ ----- (Complete in Duplicate) Date issued 1�-/ 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 thew ro k herein described. This application is made in compliance with County Ordi ante No. r9. 3 a JOB ADDRESS AND C TION f -------------------------- ---------- - Phone----------------------------• Owner's Name- -•-- --t------- - ---�' - ------ --------•--•---=------------•----------------- --- - �-- - ----- Address--•------------------------ - ........... --- ----- .... .. - - ------------------ -----------r-------------------------------------- -------------------- r Contractor's Name--------------- ------'_ ._, ---- 'eC-'-----.- Installation will serve: Residence ,I[ par+inent House ❑ Commercial E] Trailer Court E] Motel ❑ Other El Number of living units: __,!___ Number of bedrooms __f__ Number of baths __/. Lot size ___ - _.___--__________________ Water Supply: Public system UKII'Commu pity`system ❑ Private ❑ Depth to Water Table 4�?ft. Character of soil to a depth of 3 feet: Sand 0 Gravel (] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date-------!-.;----------) No ❑ New Construction: Yes ❑ No 2-"FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if,public sewer is available within 200 feet.) r i �tT . Distance. from nearest well_________________Distance from foundation----._.____________-Material________-____--___._________________.._--_____._.No. of compartments-.*...--,-- --------- - ---Size--------------------------------Liquid depth--------------------------Capacity_-- -- --------------- ( Disposal Fiod: Distance from nearest wek__XAe _. istance from foundation-----1_4�.__.--.Distance to nearest lot line_F�_�_______ F Number of lines______________________ --_-Length of each line----_- .%°..______.___._._.Width of trench___------� . ----_--------_.-- C Type of filter material.__�r_ 0_t_/e-_Depth of filter material___---/ .......Total length------------------------12z_'--------- Seepage Pit: Distance to nearest well (1h ___Distance m foundation___//,0__.____-_.Distance to nearest lot lane_____.____._ ❑� Number of pits-------/-------- _Lining material___ elf'__-_Size: Diameter------33__-------Depth......... '_______________ Cesspool: Dis#ante from nearest well--------------.---Distance from foundation--------------------Lining material__._..._-__-_____._..______________._. ❑ Size: Diameter------------- I`--------- -Depth--------------------------------:------------------Liquid Capacity-...------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---.__-__.-_----_______.______.______._._. ❑ Distance to nearest lot line------ --- ------ - ---------- ------------- --------------------------------------------------------- ------------- Remodeling and/or repairing (describe):-------- ----------------- - ] ------N---------------------- - 9 ----------------_------------------------------------------------------------------------------------------_---------------------------------------------------_---------------------------------------------------- 1 Y I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County i ordinances, Stoe laws, and rule and r ulations of the 5 n Joaquin Local Health District. (Signed) ---(Owner and or Contractor By:----------------------------------------- --- ----- --------- --rf----- --- - ------- ----------------(Title) - k (Plot plan, showing size of lot, locatio o syste in relation +o ells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY F APPLICATION ACCEPTED BY------------ '------------------•------------------------------------------------------------._ DATE-------f' ` rol -------------------------------- REVIEWEDBY------------------------- --------------------------- ----------- ----------- ---------------------------- DATE- BUILDINGPERMIT ISSUED--------------------------------------------------------------—--- ---------------------------------- DATE------------------------------------------------------------ Alt ra n and/or ret mendations: . ------------------------- ------ ----- ---- -------------------- ---------------------- ------------•--------------------------- ---------------- --------- --------------------------------------------------------------------------------------------- f FINAL INSPECTION BY:-------- - -- 1 Date ` . �� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.