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F OFFICE USE: �p --------------- f APPLICATION- FOR-SANITATION PERMIT Permit No. e. gnvz.`�---- (Complete in Duplicate) �� ------------------------ _,l._This Permit Expires 1 Year From Date Issued Date Issued _ _____.j__ 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. "MY JOB ADDRESS AND LOS,-ATI Vllo4---Ie--�Lt� i_._ cS"_.3 /O C- f J� -- cJp ��33,, 1` Owner's Name-_-G/!_�--- "�/ � _ ----- --------------------------- ------ - -------------------- ------------- Phone------------------------------------ Address--------- ---2-3� ----------------------------- -- --- ---------------------------- ----------------------------------------------------------- ---------------- Contractor's Name__Qd� �� ---------- ----•--------------------------------------------------------------- ----------------- Phone....------------•- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---]-- Number of bedrooms __3__ Number of baths _3-.__ Lot size --------------------------------- ----- Water Supply: Public system ❑ Community system ❑ Private g]--Depth to Water Table 10 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 2--Adobe 0 Hardpan ❑ Previous Application Made: (If yes,date_ ----_----------___) No Construction: Yes RT�No ❑ FHA/VA: Yes ❑ No o-- TYPE OF INSTALLATION AND SPECIFICATIONS- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Teak: Distance from nearest well_L O._"*__Distance from foundation-_�A__0_.___-_.Material_._ ..._.._ __ No. of compartments--_z------------------- depth___ --- Capacity /x---------- _-.Ca atit _ _ Disposal Field: Distance from nearest well - Distance from foundation../b___`_---------Distance to nearest lot line_J'_-t--__-- Number of lines......3--------------------------Length of each line__>rA4_'____4__o_`...Width of trench----?&--f_ 4 .--------------------- Type of filter materia'1'_1?,P_C-4--------Depth of filter material__Zi'-------------Total length_.___-'Z.1f+_9----______-____-------_ 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- --- --------------------------------Depth--------------- ----------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------ ___ ._Distance from nearest building.-.--. _--___________-_________-__---.-._. ❑ Distance to nearest lot line------ -------------------------- --------- ---------------------------------------------------------------- Remodelingand/or repairing (describe):----------------- ----------------- ---------------•----------------------------------------- -----------------------•-------------------------------- -----------------------•-----------------------------------------------....---------------------------------------------------- ------------------------------- -------------------------------------------------------------- - --- -------------- ------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify t at I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la ��ules and r ula ' ns of the San Joaquin Local Health District. (Signed) ------ --- . --------------------------------- ---------------------------------------------------(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--- <_.. 74--1--------------------------------------------------------------------- DATE----P=fid- —--------------- ----------------- REVIEWEDBY---------------------- - ------- ----------------------------------------------------------------------------- DATE----------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------------------- -------------------- Alterationsand/or recommendations:------------------ ------- ------------------------• ----------------------------------------------------------•-------•------------------------------- -------•---------------------------------------------•-------------------- -- - ------- ----------------------------------------------------- ------------------•----------------------------------------------------------- ---------------------------------- ---• - ------------------ -------- ------------------------------------------------------ ------------------------------------------------------------------------------------------------ ----------------I------------------- ------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------- --- ---I------------------------------------------------------------------- ------------- --------------- ---- - ------------------------------------------------ ------ ---------------------------------------------------------------------------------------------------- ------------------------------- FINAL INSPECTION BY: -------------- ------------ - Date ------------------------------------------I--------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harelton Ave. 300 West Oak Street 724 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.co.