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FOR OFFICE USE: �' Y. 1 _ l a = Permit No. _1 ---.---- -- - APPLICATION FOR,SANITATION PERMIT ------------------ - (Complete in Duplicate Date Issued �- -- - ------- ----------------------------------------------- This Permit Expires 1 Year From Date Issued al Health District for a permit to construct and install the work herein described. Application is hereby made to the San Joaquin Loc This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION------ a --------------------- Phone. _------- --- -•-- - ---------------------- Owner's Name--- ---••---------- r, Address - /(�(Z� - --- ------------------------------- - ---- Phone. -- ------ --------------- Contractor's Name______________________ ___ ___ ------ - Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence Apartment House ❑ ❑ - • � Lot size ---�- -- - - ----------------=------ ---- 1 Number of living units: _/.. Number of bedrooms -3--- Number of baths �Qr Water Supply: Public system El Community Depth to Water Table SQ ft.Community system ❑ - Clay Adobe Hardpan ❑ Character of soil to a depth of 3-feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Y ❑ Previous Application Made: (if yes,date--------------------) No El New Construction: Yes ❑ NOX FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well Distance from foundation__-_-----".-._-__.Materia4-___._______________________-_____.._ I ___._ -Size Liquid depth --- ------- -Capacity---------- -------- No. of compartments-------------- Disposal Field: Distance from nearest wel1..�7 d Distance from foundation.yS.-:_-"..Distance to nearest lot line__ ----- �. Number of lines----- ---- ----- -----Length of each line__. 5.......-----.Width of trench_-r.� . �-� ---Depth of filter materiaL. g--- -- Total length_._____..._____-_...__ - ------- Type of filter materialC. � Seepage Pit: Distance to nearest well."--------------------Distance from"foundation------.-------------Distance to nearest lot t ❑ � - line----------------- Number -._"_.-..-__..._ Number of pits--------------- ----Lining material---------- ------------Size: Diameter----•---------- -- --- I Depth--------- --------------------- -- nearst well from foundation-.------- ..____-- Lining material--------------.._-_-----.__,.- Cesspool: Distance from Li uid Capacity -- - gas Size: Diameter--- --- ---- ------ ----- ------Da th--------- ------------------------------------ ❑ �..� Dis#ante from nearest building-----_---------------------- k Privy: Distance from nearest well----------------------------" ------------------------ Distance to nearest lot line--------------------- - ---- --- --- ---- --- --------------------------- - if; _ ❑ I --------•--------•---------•------------------------------------------------------------------------ - ------------------ Remodeling and/or repairing (describe): ---_----_-- I ------------------------- -------------------------------------------------------- - - -----•-- --- I hereby certify that l have les andregulations alt tation he Saand that n Joaquin LacalkHealtlleDistric{n accordance with San Joaquin County ordinances, State laws, and ---- wner and/or Contractor - ---- (Signed)ned -- --------- ------ ----- {Title) -- ------------------------ --- l (Plot plan, showing size of lot, location of system in relation to well Idings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY_------- ---- -_ `3s' ,---------------------------------------- DATE.--------ell 7/�-� :- ---------------- .--- ----------- DATE------------------------------------------------------------ l REVIEWED BY-------- ------- --------- ---------------------------------------------------- - - ----------------- --------- -- DATE --------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------- Alterations and/or recommendations:------------------------------------------------- -------- --------------------------------------------------- ---------------------------------------------------- -------------------------------------------------- ------- -- -------------------------- Date.-------- '/ -- ---- ------------- FINAL INSPECTION BY:----- -----•-- AN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasslton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Lodi,California Manteca,California Tracy,California Stockton,California F.P.CO.