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FOR OFFICE USE: ' --------------------------------------------------------- ---------------------------- -- APPLICATION FOR SANITATION PERMIT Permit No. .r2Qly --------------------------------------------------------- (Complete in Duplicate) Date Issued ......................................................... This Permit Expires I 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. JOB ADDRESS AND LOCATION_ �:_t� ---- - f d ----ek------c�z_r.-_tom- - ;�•_� __ � 1 T ------ Owner's Name---------------- �� ----------- ------ ---- Address----------- ~� �L=�•/-t�' C`1. All 4 C, '"I !+ Installation will serve: Residence] Apartment Contractor's Name-------- ! �� - -'r------------------------- ----------- Phone---� ❑ p House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Qth� f Number of living units: _ Number of bedrooms __"~_ Number of baths __{__ Lot size ---------- ----------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ;�V_`ft. Character of soil to a depth of 3 fest: Sand P-Gravel Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date_------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f f Septic Tank: Distance from nearest well___-��___Dis$ance from foundation_ Q_...._._ Matefial_ _ �, li r.... No. of compartments ---------------- 5ize, _- -4-------Liquid depth---�--7r �------------Ca acit ��_-- i Disposal Field: Distance from nearest we].: --Distance from foundation-- // p ,A-�.-__.._.Distance to nearest lot line_.*_.-�.__.y._ ---- � Number of lines------ - Len Length of each line_._. Width of trent ------ g ---moi--- ;_ ------------------------- TypeT e of filter material r/ - � _De Depth of filter material____ f _____-__Total length a ----------------------- Yp �/-.� - p F-- --- g Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--.---..______.__ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter--------------------Depth--------------------------------• Cesspool: Distance from nearest well-----------------Distance from foundation....----------------Lining material---.--...___.._-___-__.______--__-. ❑ Size: Diameter- ------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. ` Privy: Distance from nearest well-.-. ----------------------- ----------Distance from nearest building----------------------------------------- ❑ Distance to nearest lot kire----------------------------------------------------------------------- --------------------- A Remodeling and/or repairing (describe):----- .- ---,.��____'_----- -'�----��1�-"-�-------- : ----- - ---- ----------------------------------------- - ------ ---------------------- --------------------------------------------------------- ---------------------------------------- ---------- ------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------- 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 r;;6ules nd regulations of the San Joaquin Local Health District. i (Signed)-------------------------- - r/`' - SrContractor) . BY:--------------------------------------- --—--------:------------------------- -- - - --------------------(Title)----. —r _ �J (Plot plan, showing size of lot, location of system in rely ' n o wells, buildings, etc., can be placed on reverse side}. I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- = ----------------------------------------- DATE-_,�17 -7-- -- --------- ----------------- REVIEWEDBY-----------------`---------- ------------------------------------------ DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------- ----------------------------------------------- ---------- DATE--------- ----------------------------------------------- -- Alterations and/or recommendations------------------------------------------------ -------------------------------------------------------------------------------------------------------------- --------- -------------------------------------------------------------- ----------- ---------- --------- --------------- --------------------------------------------•--------------------------------------------•--- 1 FINAL INSPECTION BY:_ - +ct� ------------------ Date -s- --- - -------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 7601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.P.co.