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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT . Permit No. a1l�_._____. -------------------=----------------------------------- ---------------- ------------------------ -------------- (Complete in Duplica+e} 3–� ' - This Permit Expires] Year From Date Issued Date Issued 1�_.� _______.__ 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 L ATIO __ -------/ ` ----- ----------' ------------------ Name------------- - /' / -------------- Owner's -- ----------- Phone.._...------------------------------ Address--------------------- ---- --------•f-a-�--�• --------- ------------`----------•---------------..----•-----------•----•-•- ! ' / Contractor's Name �� ue ---------------- Phone_y4 — M Installation will serve: Residence Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ _ Number of bedrooms __ _ Number of baths _c� Lot size _____4 -54 -`-------'"--- --� ! Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Tablef04 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan Previous Application Made: (If yes,date--_-_____.,....._.1 No,�ew Construction: Yes [ ❑ FHA/VA: 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__�_�.__-_-Distance from foundation_ U.________.Mate�ial_ __________________ ____________________.. l Size_y -XS--,�-•- -.---Li Liquid de th----- No. of compartments--------� -- - -- 9 q p. 1,�------------- ---Capacity__1��d� / � i Disposal Field: Distance from nearest well_5 -----_._Distance from foundation.J--Q----------Distance to nearest lot line_ -_. ____ [ / Number of lines-------- Length of each ---------------_Width of trench-----11:5?_�___------------- Type of filter material._�__W c-�Depth of filter material___. '_-_-__._Total length----------- _______________ �v J i Seepage P ." Distance to nearest well._.,IDU_: ----Distance f m foundation----O._a_------Distance to nearest lot line _ __ ___-_. Number of pits____------------Lining material____ :U4� -__-Size: Diameter._-_33---- ----Depth___-�-5 __________________ Cesspool: Distance from nearest well----------------- from foundation....--------------- Lining material _________________________ ❑ 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 I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances' e' law ;.and•rules nd re uiations of the San aquin Local Health District. r-- (Signed) -- - --------- - ------- ....... ------------ --------- (Owner and/or ractor) . . l By:---------`--------------. ;,--------- -- - f�� ------/, ---------- ---- (Plot plan, showing size;of.lo+, location of system in relation tg'wells, buildings, etc., can be placed on reverse side). > FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- Y ----------- ---------------------------------- DATE------/-p=---------- "6--- ---------------------------- REVIEWEDBY_ � 1` -------------------------- ----------------------------------------------------------- DATE------------------------------------------------------------ : - BUILDING PERMIT ISSUED - --------- - - DATE - Alterations and/or recommendations::_ FINAL INSPECTION BY:___Z lZ__-- Date--------------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.