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FOR OFFICE USE: ----- -- Permit No. 1 T f -- -------" - --- - � - --- ------------- APPLICATION FOR SANITATION PERMIT -----•-�•••--- --------------------------------------------------------- (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. ,.._ .. ( 33_Z,F.•.C_occ�/L - 0 O d`S°`! JOB ADDRESS AND LOCATION.-- ------------------------- ----------- Owners Name----- - -------------------------------------------------- ---------- Phone---------------- ----------•----•--- Address---•---- -- ---------------------- a q- Name__. i�r--+ ---A. "'--.--------- Phone...-----•-----------•----- Installa+ion will serve: Residence++ Apartment wfouse Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ VZ.____ Number of bedrooms _�___ Number of baths�_--_ Lot size _,�-- /.��-------��----------•--------------- Number of living units: _ -. Water Supply: Public system ❑ Community system ❑ Private ,o Depth to Water Tabled_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El Clay C] Adobe [3 Hardpan- ; fi Previous Application Made: (if yes,date----------- ----) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No [] i TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 240 feet.) No. of compartments--------------------------size--•------------• - q p p y ` r Liquid de th------------- -------- -Capacity------ ----------------------- Septic Tank: Distance from nearest well-----------------Distance from foundation___-----.__----. -Materia -....____-._---_ .-_ -_ . 1 Disposal Field: Distance from nearest well.../-�......Distance from foundation_--o-0---------Distance to nearest log line Number of lines----- l_.__------�p----------------Length of each line----,5 -�--------------- Width of trench_ _.____,-__.__--------------- } De th of filter material---__ ---------Total length--S?- ---------------------------- Type ---- ----- Type of filter materialk-'t_------------ p ft Seepage Pit: Distance to nearest well--_j-D"0---------Distance from foundation. _4'______-_-.Dist�nce to nearest lot lines._____.__-- Number of pits._ � - Size: Diameter-_ De th..� +�----------------------- Lining material - - Z -- p Cesspool: Distance from nearest well-----------------Distance from fbundation-----------------_Lining material------------------------- ----------- ❑ ---- ----------- ------nearestbuilding. --------- ------------- -. gals. elft 1 Size: Diameter---- ---------•--- ------- ..... Depth ---------------_-- Liquid ---------------------------- a• Privy: Distance from nearest well-_.-_--_----------------------------------------Distance from ❑ Distance to nearest lot line- - ----------- --------- - -----=-------- ---•------------------------------------------------------------- ,� I: Remodeling and/or repairing (clescribe):-- ___...-- ' E.r - " ? •z-T ^---------------•----------------- . Ill --------------------------------------------------------------------------- --- ---------- - - --- ---- ------- ------ ! hereby 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. l I � { wrier and/or Contractor] (Signed) - (O ---- - ------ - - - - ------------------------------- Title ----------- --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----.-- - ----- ------------------------------------------------------ REVIEWED - -----------------------REVIEWED BY----------------------------------- ----------------------------- DATE----------------------- ------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------- -- - ---------------------- DATE--------------------------------------------- -------------- Alterations and/or recommendations:-------------------- -----------------•------ -------------------------- --'---•-"--- t ------------------------------------------------------ - ------------------------------------------ ------------------ -------------- ------------ ------------ -- INSPECTION BY:..- Date j� .. ------------- -------------- ------------------------- FINAL SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maseltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street g Stockton,California Lodi, California Manteca,California Tracy,California f F.P.CG.