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FOR OFFICE USE: 11-7 ------------- APPLICATION FOR SANITATION PERMIT Permit --- -------- --------- -- ------------------------ (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--- OD � ----"---------------- m" ---------------------------------------------- Owner's Name-------`9_,_A......K ---------------- Phone------------------------------------ d Address-.................................... �_ _ _ -e-------------------------------------------------• --- -••--•--------------------------------- Contractor's Name------ - 1 1 G-k+-----�--�._1� -...ZJX=--------------•-•--•--._. Phone_*'O/ 4n� f �. Installation will serve: Residence U,-<partment House ❑ Commercial ❑ Trail r Court ❑ Motel E] Other ❑ • ,r Number of living units: __�__ Number of bedrooms _ Number of baths _. ____ Lot size ._-_- __�_ -- --------------- Y Water Supply: Public system E] Community system bedrooms Depth to Water Table-}__ tt. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [] Adobe ardpan ❑ 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.) : Distance from nearest well_________________Distance from foundation--------------------Material_____.._______..__.-___________________.________- No. of compartments--------------------- ----Size------------------ ------- -----Liquid depth--------- ------- --------Capacity------ ------------- Distance from nearest well___.............Distance from foundation----------------.---Distance to nearest lot line________________. t Number of lines-----------------------------------Length of each line-----------------------_---_--Width of trench-------------- ------ Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ Seepa e Pit: pistance to nearest w II4p_D____..__--Distance from foundation____1_Q__.___.[?ista�f to nearest lot line______-____�__ Number of pits_______ ______________Lining material__R__ •. Si,,: Diameter-_48 ._._ . 00 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 line---------------------- ----------------------------------------------------------------------------------------------------- ---- Remodeling and/or repairing (describe) -----------------------------------------------------•-------------:-----------1.-1--- -------------- ------------•---•-------------••-------------------------------------------•--•-------- ------------ ----------- ------------ - -%�--------- ------------------------------------------------ ------ ------ -----------------------------------------------------------------------------------------------------------•----•---------------------------•--••---•---------------------------------------------- --------- --------- ---- I hereby certify that I have prepared this application and that the work will be done in accordance with Sari Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ' (Signed) ___I _l�- _�% '.._. -- • ---- ---- - -- -- ---------------------------------(�•o Contractor) \\ w Title . (Plot plan, showing size of lot, location of system in relation to wellbuildings, a ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------------------------------------------------------------- DATE--/,P_--`--_3---:�t 7` -------------- - REVIEWEDBY--------------------------------------------- -------------------------------------------------------------------------------- DATE----------------------------------------------------- ---- BUILDING PERMIT ISSUED------------- ------------------------ --------------- DATE---------------------------------------------- ----- -------- Alterations andLor recommends ' ns:_ _ .___ - - � -s ----- ------ ., ------------------------------------ --- --- ------------------------------------------------------------------------------------- --------------------------------------------------------------------------I----------------------------------------------------------------------------------------------------------------- ------ -------------------------- FINAL INSPECTION BY:.._ @,5.�__.____` LL_.)tt _ Date..... ._ 4 --- ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC. l