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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -1�..--__.. ------------------ ------------------------ ------------ (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. �" of JOB ADDRESS AND LO TI Nk - ------lz�--- Owner's Name '� ---- --------- Phone--------- -------------------------- - ---- Address---------------------- �]`� -------•----------•- Contractor's Name-1,;;; - Q - Phone. -T- 7`` Installation will serve: Residence (�partment'House ❑ ommercial ❑ TrarTer Court ❑ Motel ❑ Other ❑ IZ— Number of living units: _i -- -- ��.__�------------- Number of bedrooms _._____ Number of baths _______ Lot size _. Water Supply: Public:system [�Community system El Private E] Depth to Water Tableft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0--lHardpan ❑ Previous Application Made: (If yes,date------------........) No ❑ New Construction: Yes ❑ No•W -FMA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Q(� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) \` ti Distance from nearest well-----------------Distance from foundation-------------------Material-_____-_-._--_._------..---__-_----_______-_-__. 1 No. of compartments-- --- ------- ----------Size------------------------- -- ---Liquid depth------------ ---------- Capacity---------- ---------•- Length of each line._ Q� _._.r_�____. Width of trench-.. _ ---�� ' o Distance from near st well_140-9a.-Distance from foundation---__ Distance to nearest lotline ` Number of lines----- _---- - <� f Type of filter material.- -- ,__ -01-Depth of filter material_-.-_----- - Total length------ --------= Q-------- ��_... Seepage Pit: Distance to nearest well ._ sv2_�____--Distance from faundation_2Q.__.__.Distance to nearest lot 4ine.... __ Number of pits....---------------__Lining material-ROCK --...Size: Diameter_--- ------Depth---Z-..�- ------.------.--- Cesspool: Distance from nearest well-----------------Distance from foundation___.--------------..Dning materia l--.._.___._.-.._--.-.------_____-----. S.. ❑ Size: Diameter----------------` --------------- ----Depth--------------------- --------------- -------------Liquid Capacity------------------------•---gals. Privy: Distance from nearest,well------------------- ___._._. -----------------:--- ...--_--Distance from nearest building-------------------_.__-._-.____ ❑ Distance to nearest lot line---- ------------ ---------------------------------------------------------------- ------------------ ------------------------ Remodeling and/or repairing Eclescribe)---------------------- -------- ----------------- -------f� ---------------------------------------- ----------------------------- --� --- -- ------ 1 �' - ----------------------------------------- ---------------------------------------------------------------- ----------------------------- -------------------------------------------- ----- ! hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,Cb Irules and regulations of the San Joaquin Local Health District. [Signed) a ' ±-,`�� ---------------------- ( Contrect ) SEP'T'IC TANK 99R' q ------ ---------- or By.2-aL5.E_MinerAve..-=-k'1):`�------------------------------------------84 Title ---- --- --------------- -------- - ( (Plot plan, showing size of lot, location of system in relation wells, buildin etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- -- - ------------------------------------------ DATE REVIEWED BY- --•------- DATE------- ---------------------------------------- --- ------------------------------------------------------ BUILDING PERMIT ISSUED---------------------------------- ----------------------------- DATE Alterationsand/or recommendations:.---------.---------------------------------------------------------------------------------------- ----•- --•-------------- ---•------------------------------- FINAL INSPECTION BY:---------- Date--------------- �/3. 1. - ------------------- ------------- r �/►�-.-. - --------------- �` � -- ' 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 F.P-CG.