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t-UK Urric.L USL: — —� ------------ -- 9'3 t ----- ------------------ -------------------------------- APPLICATIOWFOR .SANITATION PERMIT Permit No. . .._d�.......... ------------ ----- -------------------- --------------- _ (Complete in Duplicate) -------- ------`- This Permit Expires 1 Year From Date Issued Date Issued Applica4ion is hereby made to the San Joaquin Local Health District for a permi construct and install the work herein described. This application is made in compliance with unty Ordinance No. 549, JOB ADDRESS AND LO TION__.._-___ _ __ -_- �; ------------------ -------------- ------------------ Owner's Na Phone Address_.--- _1---- --------- At - --------------- ---- --- f Contractor' ame----------------- --• -- ----•- t�_ �.,� N C. ------------------- Phone..__ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ) Number of living units: -------- Number of bedrooms ________ Number of baths -- _. Lot size ---------------------------=----- Water Supply: Public system ❑ Community system ❑ PrivateDepth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeK 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.) Septic Tank: Distance from nearest well . _-- _ a_s-----Distance from foundation-,4_______.-..Material____---- __________ ------='------- � No. of compartments_-_- .. ______________Size:�x___Z_. tt • -• -----.Liquid depth_..-5--�--- --------Capac,ty„ o jF I Disposal Field: Distance from nearest well.4PQ_------Distance from foundation__!O___.__--__.Distance to nearest lot line.------_ _____ Number of lines_________..___._ .__ - Length of each line----g,�-------------- Width of trench-__ �o� Type of filter material --___Depth of filter material_._.__ Total length _- ------- Seepage -_ - g 7------ See a e Pit: Distance to nearest well-4-0-0 �,fr"om undation_._ p g 1�_____.___.Distance to nearest lot line__ Number of its---- -Linin material_a��.+�... ----.Size: Diameter--- r -: Depth �--- ----------------- Cesspool: Distance from nearest well_________________Distance from foundation. Lining material__._...___-- _.________.___---i'_-___. ❑ Size: Diameter---:--- -------------------------------Depth--------------------- ---------------- - - --- ----Liquid Capacity --------------------------gals. - Privy: Distance from nearest welt --- from nearest building -'------ Distance to nearest lot line-------- - � ----�------- --------------- -----�------- ------------ -- Remodeling and/or repairing (describe):----_ ---. -. - - -- �-------- GTW _. --------- ------- --------------j� -------- --- ----------- ------------------------------- thathe - - - ------•------------------- -------------------------------------------------------------- I herels certify that I phavl, paredthis app'cation and that t e work will be done in accordance with San Joaquin Countyordinances, ';✓tate laws, andd regulation the San Joaq Local Health District. er o (Signed) 1 ----------- - - -- --------------- ---- -- Owner and/or Contractor) BY:----- ------------------------- ��`-" -------- Ti le • . -- - f------ p (Pat plan, showing size of lot, location of system in relation to wells, buildings, etc., can be plat d on reverse side), FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 13Y --- --- ----- - - - - -------- DATE----- — IEWEDBY-------------------------------------------- -- -------------- DATE BUILDING PERMIT ISSUED – ATE ;. -- - - ------- Alterations and/or recommendations: �GG --------- -.�----- - ---------- ----- -------I- FINAL INSPECTION BY:..--------- --4J-- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haseifon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California