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'F 'FOR OFFICE USE: 31--j--q j �`�-- --------- r o_ 1—!7 -- APPLICATION FOR SANITATION PERMITPermit Na d --------,- -I v- -- -( ----- ----- (Complete in Duplicate) Date issued.._��.�_f�=�� -------------I-------------------------------------------- This Permit Expires I 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 Ordina e No. 549. Ax, JOB ADDRESS AND LOCATION---- /. --- -- ----� 1 - � 7�— ------------------------------ M Phone-------------- ----------------- r Address' r ----------- ------------ ----------- -- ------ Contractor's Name------µ� � f - Phone. Installation will serve: Residence 93'-Apartment House ❑ Commercial's❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms _.-?_ Number of baths /___ Lot size ---------------- ----- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table " Character of soil to a depth of 3 feet: - Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe �ardpan ❑ Previous Application Made: (If yes,date-,..................) No V�- New Construction: Yes ❑ No Ra-'FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tan�: % Distance from nearest well_________________Distance from foundation------------------- Material__.___.._-------_-.._____________-.__._._______- r lP7.41' No. of compartments-------------------------Size__._ _------------------------Liquid depth---------- ---- ----- ---Capacity--------r- ------------ Disposal Field Distance from nearest well.._._____ ------Distance from foundation___ ___-Distance to nearest lot line_ :_ ...... Number of lines_________`_______ ength of each line____!��''r✓ - Width of trench-.t°_ -------------------------- Q Type of filter material--/- . _ epth of filter ma terial----< ___-------Total length-_- ------------------------_____________..__ - s Seepage Pit: Distance to nearest well---- f_---------Distance frg�n fou dation__ ____ __________.Distance to nearest lotjne.. _—� v �` ,� Number of pits---_ --------------Lining material---_._ __-Size: Diameter___7' �--------.___Depth— E/�� ------ C:) f Cesspool: Distance from nearest well-----------------Distance from foundation-----------.-------.Lining material____.._______-_- --�`-r-� ❑ Size: Diameter---- - ----------•----- --------- - Depth----------------------------------- ----------------Liquid Capacity- •-------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ r-1 Distance to nearest lot line-------------------- ----------- ----------- ------------------------------------------------ ---------------------------------------------- Remodeling and/or repairing (describe):----------- ----- =� ------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------•---------------------------------------•------------------------------------------------------------------------------------------------------------------------------ '"Thereby 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 and regulations of the San Joaquin Local Health District. (Signed)-------------------------------------- (�r Contractor) . --- ----- --- -- f ------------- By:------------------------------------------••-•----------------------------- - -=G--< - - __f---------(Title)--- - - ----------..... ------- (Plot plan. showing size of lot, location of system in rel to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY : APPLICATION ACCEPTED BY--- - -/eZ'Z - - ------- ---------------------------------------- DATE------------------------------------------------------------ REVIEWEDBY---------------------------------- - -----_/---------------- -- -------------- ------------ --------------------------- DATE---- ------------------------------------------------------ BUILDING PERMIT ISSUED------------------------------------- --- 1. ----------- DATE-----------------;---------- ----- ------- - -------------- Alterations and/or rerpommend-a- tionss�---- . _ -- -----�-_ ....... ----- -------- ------------- ------------------------------------------------------------ ------------------•---------- ---------- ------------------- -•------------------------ ----------------------------------------------------------------------------------------- FINAL INSPECTION BY:---------� ---------_------- bate �j SAN JOAQUIN LOCAL HEALTH DISTRICT . 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California r.P.Cu. l