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FOR OFFICE USE: e ------------------------- ------------------------------- �d -------- :-- -a-------- ------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ._J1�_4.. . ------------------------------------------- {Complete in Duplicate] - _ �. Date Issued -------------------___---_--------------------------------- 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 is made in compliance with County Ordinance No.,549: - -JOB ADDRESS - � .�e& -.---------------------------------------.`-7-�------•-�--�--- -_---- --- j Owner's Nam�� ... n1 /&--------•--�l1� e- ------------------- '------------- Phone.// ------------ . -- -.....:.......Address---------- ........ ----------- Contractor's Name----------------------------------------•------- -----* Phone-------------------------=------.--------- _1-------------••--•-------- Installation will serve: Residence ❑ Apartment House 0 Commercial E], Trailer-Court ❑ Mote! ❑ Other B-4r&11A�rP Number of living units: __I____ Number of bedrooms 4__ Number of baths ------- Lot size ---------_____.____:__'____________________________________ Water Supply: Public system ®Community system [] Private ❑ Depth to Water Table .r- ft.- I l Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ra—Hardpan ❑ Previous Application Made: (If yes,date---------_,......--1 No © New Construction: Yes --qo ❑ FHA"_ : 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__ __l_Distance from foundation___-0-----------Material----COWe-ee�/----------------- �'. No. of compartments--------•Z-------------Size---------------------------------Liquid depth----------- --------------Capacity�.g_yw Disposal Field: Distance from nearest well---6.O_ ...-.Distance from foundation_____ Q_`___._Distance to nearest lot line_____Cf �._. Number of lines____,______. Length of each line_ '�D `� L� -----=- ---- -- g �-----� -�_fI__._...Width of trench-----�`-`�'-------------------- ,Type of filter material_AJ. _IF-rtl____.____Depth of filter material___: ________.Total length----------- - ---_____________._ Seepage Pit: Distance to nearest well---tP!.0._.-------Distance from fo6ndation_.A1,O-_____.__- Distance to nearest lot line-----•7:______.__ Number of pits------- ...........Lining material__4Qo_-4---I----Size—Dia meter____ ...........Depth--------Z_ti-___-_--__-_ Cesspool: Distance from nearest-well-__ __'._t___Distance from foundation--------------------Lining material_._...-_-___--__-____------__-._. � Size. Diameter--------------------------------A---Depth-------:-----------t------------------------ -----.Liquid Capacity gals. i Priv Y Distance fromEnearest well___._.___._# Y Distance from nearest building------------------------------------------ Dist ance - Distance to nearest lot line------------_ � �„,�.wt+•w^^---sem .,Y, ------------------------ Remodeling and/or repairing (describe) =-------------------------------------------------------------------------------------- --..-----e--------------------------------------------------------------------------------------- ! \. --------------------------------------------------------------------------------- --•------ ------- N ------------=-•-------------------------------------------------------•--------------------=------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat ws, and rul and u +ion�AeSa aquiLocal Health District. {Signed)---- . . - ----------•----- --------------------------------- --------(Owner and/or Contractor) By:---------------------=------- --•----•-....... ........------------------------------------------------------- r (Plot plan, showing size of lot, location of system in relation to wells, buildings, .e+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- � - ---- -------- --- DATE-------- ------------------------ -- REVIEWED BY - - - '-------- --------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED rs ; ------------------------------------------------DATE------- ---- --- - -/ -------------- Al+era+�lotn{s a recommendations:------ �- --�----/- 7"P�.e-€�- �- '---•------------------ --• ' ----- l + --- ----- ----- -----•----• ------------------------- l ----------------------------------------° ------------------------- - ------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:.-- __-- Date_--_- -_ Z SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazoltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th street Stockton,California Lodi,California Manteca,California Tracy,California Es 9 REvis EP a-S9 3M ••G3 r.p.co.