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.... _�.. ----------------- ------------ --- 1 --- ------------------- APPLICATION FOR SANITATION PERMIT Permit No. .....IE.?7f -------- --------- --------------------- ------- (Complete in Duplicate) ----------- This Permit Expires 1 Year From Date Issued 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.AND LOCATION --r--- C lR k +L�--- .M.t- --- Owner's Name L. --------- '------------ --------------------- Phone_----------- Address 3 -- � Address . [ ) 1- -----------------------f' �- -------------------- - --------------------------------------------- Contractor's Name �se � Phone , - -- -- -------------- _.. Installation will serve: Residence Apartm ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: __ -_ Number of bedrooms ___ �--Number of baths --.j-___ Lot size ____�_____ Water Supply: Public system ❑ Community system ❑ Private [/Depth to Water Table 60ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ®Clay ❑ dobe ❑ Hardpan ❑ Previous Application Made: (If yes,date___- --------I No T-_`New Construction: Yes ❑ No FHA/VA: Yes ❑ No Rr TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well _____------- ___Distance from foundation--------------------Material--__- -------.-----------_-__ ❑ No. of compartments-- -------------------�_Size---------------- ------------ Liquid de th---- - - ----------------Capacity------------- - Disposa Field: Distance from nearest well_. _�-. Distance from foundation___. I --- ------.----- Distance to nearest lot line___ ____________ Number of lines-------------- -- ----- ----Length of each line--------34!)i--- ---------Width of trench.---- -{-----------_----- f'� Type of filter material__ h_Depth of filter material___ . g - -- --- ----Total length -•-------------------�- Seepage Pit: Distance to nearest well-_100-1_____Distance f om foundation___'2_%_1-____.Distance to nearest lot line-7,S_ --__ Number of pits____8 N.C, _-__Lining material_ .- Com..-Size: Diameter._._ °' � 3 3 Deptn � -- ------------- .'„ W Cesspool: Distance from nearest well---_-------------Distance from foundation___________._____-.Lining material-.-____..------------__.-___._- ---- El Size: Diameter Depth .: ,.r Liquid Capacity. gals. i Privy: Distance from nearest well__-_-------,__---------------------�_._---____6stance from nearest building.-_----__-._______.____----------- .� .. i ,. ❑ Distance to nearest lot line------I--- ---------------------- Remodeling -------------- -----Remodeling and/or repairing (describe):. -------- --------- - ----------- --------------- 1 - =------------------------------------------------------------ • ,. = - - m -- - -- ----- i -------------------------------------- - - - - - - - - - - - -- - -------------- 1 hereby certify that I have prepared this application and'+hat the work will 6e done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------------- PA-P-04t,14 -.-1.�- (Owner and/or Contractor)- --.-- ._ ----- -- -----(Title)------ RY P o+ plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION4ACCEPTED BY------ .------_- ..` _-_ _ 6�s-`�_ --------------------------------- DATE ----------------------- REVIEWED BY ----------------------------- - -------------------------- DATE------------------ BUILDING PERMIT ISSUED-------------------------------------- ------ DATE--------- - - - Alterations and/or recommendations:_-_-- ____._ _-._- -. __-_- ----------------�----- f ------------•---------------------------- P ________________________________________ 8. . k. v '_ .. FINAL INSPECTION BY:__- __. •:_ -------- ------- / 7 � ---• ---, Date- , ------- --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 W st Oak Street 124 Sycamore Street 205 West 9th Street 1 Stockton,California Lo ,California Manteca,California Tracy,California F.P.CO.