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: FOR FFICE USE: .. 1 7 r-- w APPLICATION FOR SANITATION PERMIT Permit No. ..1 �... j -------------------------: ._.._._----------- (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 LO.C- TIONr ----------------------------------------------- Owner's Name _ ./!�l ------ ------------------------ ----------- Phone------ ----------------------------- Address--------------------------- �� - J =�? /L'� --/t Contractor's Name___-..-,! s____�``'�c_----- __-_- Installation will serve: Residence © Apartment House ❑ Commercial E]', Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j__._ Number of bedrooms __Y Number of baths __./__ Lot size __X.l -------___________________ Water Supply: Public system ❑G--*'Community. system ❑ Private ❑ Depth to Water TableA.'-5_ ft. f Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0--Clay❑ Adobe ❑ Hardpan [❑ F Previous Application Made: (If yes,date--------- ---------) No ®,"New Construction: Yes ❑ No ❑`_FHA/VA: Yes ❑ w 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_________________Distance from foundation--------------------Material-------------------------------------___.......... ❑ No. of compartments--------------------------Size-------------------------------Liquid depth-----------------------Capacity-----------•--------_-- 1 Disposal Field: Distance from nearest well- __---------Distance from foundation -----._.Distance to nearest lot line__fl___,_._. 0/ Number of lines-____._____�____ ____________--Length of each line-_.f f�__`_____�r.__._.Width of trench___. E,f __-f.--_----- Type of filter material__ ,! _ Depth of filter material---Z ----_Total length_______ ___.___1 ..... ' Seepage-Pit: Distance to nearest well w._., -_'f' ___Distance f m foundation_ . _!_.Distance to nearest lot line_____ _ p� ❑� Number of pits------.%.___.._____.Lining material-`pF��" ---Size: Diameter____��w-----.Depth---- --- -------------- N Cesspool: Distance f m nearest well__:_---- -Distance from foundation--- material-_____________________________________ Size: Diameter----------- ---- ---------..De th-------------------------•------- --------- ------Liquid Capacity ❑ p, q - ------------------------gals. Privy: Distance from nearest well-- ---_-..--_-t---_._._....... .......Distance from nearest building. _ __----------__________.------_ ❑ ! i Distance to nearest lot line ------------------------------------------ Remodeling and/or rep � describe):------------- / _--/ _._r__ _ ----- lKe = �----------- ------- ----------------------- ------- ..� ��--------------------------------------------- ------ ---- -- --c ------r-"y,- e ._�-PSC��_— 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 Loc I 1#h District. y� I I (Signed � � rz, �---==r •------- ----------- Own "and/or Contractor) r � ��r- - ' -------... ----=------- ------ `- '---" Tttle ' - = ' -x (Plot plan, showing size of to+, location f sys+em in relation to wells,` buildings, a#c., can be placed on,reverse;side). FOR�DEPARTMENT USE ONLY i APPLICATION 'ACCEPTED BY----------------- r -�-:_________________ DATE--REVIEWED BYI---------------------------------------- -'------ -----------------------------------• DATE--.-- - _.,i BUILDING PERMIT ISSUED - __-- • �__ - . DATE.------------ � ----- -- ------------ ------- Alterations and/or recommendations:------Fk --- ?__�� ---- t -- -- ------------------------ ---------------------------- ------------------------------------ --------------------------------------------- ------------------------------------._.--------------------------------- -------------- FINAL INSPECTION BY:.._.�pj ----- ---- � ___-_-- Date---./ `�� __ ---- ' t SAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street r6 s 124 Sycamore Street { 205 West 4th Street Stockton,California Lodi,California st Manteca,California Tracy,California F.P.CC. A