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FOR OFFICE USE: --------------------------------------------- - --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. —----------rp� -+ (Complete in Duplicate) a '� --------- ---- ----------------- Date Issued � � ! -_.--_"". `This Permit Ex ires�l 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"Gounty Ordinance No. 549. ------------------------------------------------------------------------------------ ,gypLOCATION JOB ADDRESS �• - - �/Owner's ----- --- � ------ '� , Phone--f�--__----- Address------------'� ---------- ------------------------------------------------- --- -------------------------------------- --------•- k ------------ Phone----------------------------------- Contractor's Name--------------- - -- 11 Installation will Terve: Residence [_1 Apartment House ❑ Commercial . Trailer Court ❑ Motel El Other El . Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size --------_------------------- Water Supply: !Publicsystem ❑ Community system ❑ Private [4 Depth to Water Table _& -_ft.�VW, Character of soil to a depth of 3 feet: Sand C] Gravel F1 Sandy Loam E] Clay Loam [IClay ElAdobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes No E] FHA/VA: Yes [I No E] TYPE OF INSTALLATION AND SPECIFICATIONS: \ I. (No septic tan0or cesspool permitted if public sewer is available within 240 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------.Material------------------------------------------------ . . ❑ No. of compartments------- ------------------Size------------------- ------ -----Liquid depth-- Capacity.. L Disposal Field: Distance from nearest well-----------------Distance from foundation-------------------.Distance to nearest lot line----------------- ❑ Number of lines-----------------------------------Length of each line------ Width of trench ".Type of filter mater•sal-----------------—-----Depth of filter material_---.-.___.l---_____.Total length---------------------------------------- Seepage Pit: Distance to nearest well_.. / .--.____._Distance from foundation-- Distance to nearest lot line.-��<� L f its---------- ----------Linin material--- .@ Size: Dia+aaeier. �QrY��_-�----Depth------- -------------------- Cess ool: Distance a p g ,�. ! C Number o ''#rom nearest well________________Distance from foundation-.-._.�^.`._—Lining material--------_..-_._.______.---..__..___ p %,-- , ; , ❑ Size: Diameter.---. ---------- ----- ----------Depth----- ------------------------------------------Liquid Capacity----------------------------gals. 'N I Privy: Distance from nearest well- ____ ----------------- �----- _._---Distance from nearest building----------------------------------------- Distance ------_-------.-- --_-------_-_--...- Distance to nearest lot line-_ ----'---- ---- ---- ------------------------------------------------------- a Rem deling and/ori ep firing ( esc�6e) __ _' -- .___ _ ____._ .,____- --_--_--_ ------ ____ ----- ____�-- Q---- P J - ------ -------- +#I ` f --------------- I hereby certify that I have prepared is applica on and that the.w,ork,will=be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin LocalHealth-District. -"�- ' `� ^v.<�11:,r _ �` - ------------ (Signed) (Owner nd/or Contractor) --- { _ *.-- . .r l By: --------- _----- - ----`-------,'- ------------(Title)------- ----------------------------------------- ------------- --i-------- - (Plot pian, showing size of lot, location of system in relation to wells, bui}dings,getc., can be placed on reverse side). I FOR DEPARTMENT,USE ON' f� --6 APPLICATION ACCEPTED BY--------- --------------------------- DATE-_ - REVIEWEDBY # DATE------------------------------------------------------------ fSBU1LDING PERMIT ISSUED--------------------------------r-------------------------------------------------------------- DATE = Alterations and/or rec mmendatto s: r dr _ ------- ------------ -- . �"' . �, FINAL INSP C ION �t '' l At Date-_------ - -J,3 ------- ---------------------------- i 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 x