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FOR OFFICE USE: ,w --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ................ -------------- ----- ----------------------------------- (Complete in Duplicate) - - Date Issued Date Issued --- --------- --- This Permit Expires 1 Year From .--.. 2 -- 3 20 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 maderinrcompliance with County Ordinance No. 549. JOS ADDRESS AND sp4-...r_.26.1_-49,----- --- 1= Owner's Name-----rPl _, _. ===T/ ........ - - - ------------------------------------------- Address...... ----------------------------------------Address------ ---------- ------- - Contractor's Name---------------------------------------------------------------------------------------------------------------------------------------------- Phone----------------------------------- installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ .01 � Number of living units: __1---- Number of bedrooms __ _ Number of baths __JG-- Lot size -___/P�_ �._.�1�= -------------- Water Supply: Public system ❑ Community system ❑ Private 2j-'5epth to Water Table/�W,- 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---------- ---------) No Er'o New Construction: Yes [3 -No ❑ FHA/VA: Yes ❑ No [�r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if pu6lic sewer is available within 200 feet.) x�z f Septic ank: Distance from nearest well----6 --.---Distance from foundation ! _ Material - ---------// _�� No. of compartments------_... DL---------Size---c ......Liquid depth------.�.5... Capacity._.__c�7 .._-(f 1 Q1 D W Dispos Field: Distance from nearest well----6-------.--Distance from foundation----_-.-----.._-Distance to nearest lot/line----- Number of lines---------------- _iLeFi ength of each line___��`7__w____.....Width of trench.---_.-Z-._--..-.-_.__..____..___ Type of filter material-_,49-is_tG -Depth of filter material __Total length....__ ._ lI Seepage Pit: Distance to nearest well---------------.------Distance from foundation--------------------Distance to nearest lot line--.---------_----� h I ❑ Number of pits----------------------Lining material----------.------------Size: Diameter----------------------- ❑ Dep th----------------:--------------_ ___________Cesspool: Distance from -nearest well_____-__-_-. -_Distance from foundation--------------------Lining material___ _ .___---.-.-.----._ gals.Size: Diameter.� ------ Depth — '!4? __ -Luid_Ca aci•tY - � Privy: Distance from nearest well-------------------------------------------- ----Distance from nearest building..-.-._-_-.-_.______-___--_------_-_._. ❑ Distance to nearest lotline---------------------------------- ------------- ----------------------•--•---------•----------------------------------------------------y. . Remodeling and/or repairing (describe):------ V// -cp---- ---------------------------------- f1� ---------------•-------•----------------------------------------------------------------- ------------------------------------------------------------------------------------- ------------------ -•----------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------i -_ - I 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. f7 L Sined ---.� �z-` ' ---------------------------------------------------------------(Owner an ) BY:-------------------------------------------------------------------------- ------------------------------------------------ -- -----(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 r-C . -------------------------------------------- DATE----- I46- ------------------------- REVIEWEDBY------------------------ ------------------------------------------- -------------------------------------------------------- DATE-------------------------------- ----------------------- BUILDING PERMIT ISSUED-------------------------- D TE---------------------- ----------------------------------- -- ----------- ------------------------------- -- Alterations and/or recommendations:--------- ----------� ----------- -------- ----------------------------------: --------------------------=-----------------•-- --------------------------------------- ------------------------- - -----------------•---------------------------------------------------------- J ---------------- -- ------------------------------------------------------- ----------------------------- -- --------------------------------------- ------------ --------------------------------------- i ..---•-------------------------------------- ------- -------------------------------------------------------------------------- ----------------------------------------------------------------------------------------- ------------ ------------- ---- ------------------------------------------ --------- - - ---- - - ------------------------------ --------------------------------------- - - -------------------- FINAL INSPECTION BY:.--- �----------- -- ----- .-- Date - - ------------, r .......... / -----------------•---- I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.tta:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.ca.