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FOR OFFICE USE: - -- ------------ ------------- ------------ '_:___----__.. APPLICATION FOR SANITATION PERMIT Permit No. __�� Y`--------- -------------- --------------- -- ------------ (Complete in Duplicate) --- -- ----------------- This Permit Expires i 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. p� EL iC vE,J 774 S l ' , JOB ADDRESS AND CATION--- ---/41--------,5-0st___ 01, ,v �$ �� e� -- ------------------------------------------------------- Owner's Name / ----------- ----------------- ------------------- ---- ------------------ Phone---5F-�'r--.26------- Address --•--- 70 C Contractor's Name--------------------- __-_ --------------------------------------------- Phone_._._ Installation will serve: Residence ❑ Apartment House ❑ ommercial X Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __-.-^dumber of bedrooms -------- Number of baths -------- Lot size -j-)A-t " :_'------------- Water Water Supply: Public system ❑ Community system ❑ Private J4 Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe J9 Hardpan ❑ Previous Application Made: (If yes,date-----.--------. _J NoN New Construction: YesK No ❑ FHA/VA: Yes ❑ Noo 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_._.15 - --------Distance from foundation____-ZA_ ------Material---.- No. of compartments-- .2 .-_____ ab Liquid depth Size _ -;yC -- Disposal Field: Distance from nearest well-- -_Distance from foundation___.__ .. .__ __--_-Distance to nearest lot line____"_-. Number of lines_______,__________ ________Length of each line__ --------------- Widfh of trench—.-��-.___--- Type of filter material---- G' ..----Depth of filter material____.____-__-- ----Total length_- _-_-:-_ 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--- ----------------- - _------------Deofh- ---------------------------------------- --------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------__ ----.-----Distance from nearest buildin ❑ Distance to nearest lot line__________________________________ Remodelingand/or repairing (describe)_----------------------------------------------------------------------------------------------------------------------------------------------- ----------- ----------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------- 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 Local Health District. / J (Signed)------------a-6- A�- -, ;1 J-------------------------- -- -----------(Owner and/or Contractor) By:-------------------------------------------------------------------------- ----------- Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- - •----------- ------ --------------------------------------- DATE------------------- ----------------- REVIEWED BY - - DATE ------ ------------------------------ BUILDING PERMIT ISSUED -------------------- - --------------- DATE-- -------------------- - Alterations and/or recommendations:_-_--_.............. ------------------------------------------------ ------------ -I-------------------------------------------------------------------------------------- ------------- ------------------------ ---- --- ------- ------ -- ------------------------------------ ----------------------------- ------------- FINAL INSPECTION BY: - - ---------------------- ....................... Date------------------ / j 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 Tracyr California F.F.0 O.