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FOR OFFICE USE: --------------------------- -- - - - - ----------------- APPLICATION FOR SANITATION PERMIT /Date mit No.`--o2..4J.._..- ------------ -------- ---' --------------------------- (Complete in Duplicate) ____________ ______ This Permit Expires 1 Year From Date Issued 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, 544. JOB ADDRESS AND LOCATION is ------ -------------------------- `- ------ `--------------- Owner's Name_ 4f..f_- - �s. -------- ---------------------------- --- ------ --- Phone. Address i F------------ -- --------------------- -------------------------------*-----•------------------------------•----------- Contractor's Name------- " Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: __ __ Number of bedrooms _.. --Number of baths ._ _._ Lot size .. `+�---p-------------------------- Water Supply: Public system ❑ Community system 9R'lrivate ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Ciay Loam ❑ Clay Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date.._..___..- -I No New Construction: Yes ❑ No FHA/VA: Yes ❑ No P' TYPE OF INSTALLATION AND SPECIFICATIONS: I�T1 (No septic tank or cesspool permitted if public sewer is available within 200 fee+.)f r Septic Tank: Distance from nearest well_____—.---_--Distance efrom foundation-A!9---- Material._e._e-,eF -------------- rh ET- No. of compartments.--.-�--------------Size_ .______. l ----Liquid depth-----`� ............Capacity-.:p -_---_ C Disposal Field: Distance from nearest well--._^-------Distance from foundation--_xfJ-----.-.Distance to nearest lot line--�¢ ---- Number of lines__-.-_-- ______ Length of each line--- .., ` � �---- ----------- 9 �-�-----��-----Width of trench-el - ------- Type of filter material ` _-Depth of filter material---Z�-_------_Total length......$19—_------------------------- 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 foun`dation------------------- Lining material------------------------------------- [] Size: Diameter----------------- ----------------Depth----------------------------------------------------Liquid Capacity-.-------------------------gals. Privy: Distance from nearest wefl-------------------------------------------------Distance from nearest building_----_---_-------------------------------- ❑ Distance to nearest lot line-----------------------------.--- ---------- ------------------------------------------------------------------- ---------------- ---------- Remodeling and/or repairing {describe}:------ -- - .�d�-��%� ----------------- ------------ ----- ------- - -- --- - --------- ---- - - ---- ----------------------- -� -------------------------------------------------------------------------------�-------------- ----------- � ----------- 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. (Signed)----------------------------- --- --------- -------- ---- --------------------------- ------- Contractor) By:------------------------------------------ ----------- ---------------------- --- - ----- ---- - ----- (Plot ---(Plot plan, showing size of lot, location of system in relat' to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------- --...........---------------------------------------------------- DATE------------------ - REVIEWED BY.- ------- --------------------------- ' ' --------------------------- - DATE -`� J'G BUILDING PERMIT ISSUED------•------ --------------�-------- ----------------------- = ---{6- --- DAT£-----------------= ------------------------------------- Alterations and/or recommendations:----------------------------- --------- ----------------••---------------= - ------•----------------------------------- - ---'--------- - ------ ---- ,- ----------------------------------------------- ----------------- / a! �� �� f `� --�` — — — ' Y � --------------------------------------------------------------------------------------------------------------•----------------------------------------------------------_------------------------.._.---------`-------------- - --.------- _______________---_---------------_________________________ _______________________________________________--------------------_---------------------------- ______ ___ ____________________________________ FINAL INSPECTION BY:.___________ r r/_ - '}- ---'-'-' ----�'------------- Date------- - -------'-'----'-'------'---'--'---'—- ---------------------- SAN --'--- -SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California r.P.co.