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FOR OFFICE USE: I — vq �° s --------------- ----------------------------------- _=� APPLICATION FOR SANITATION PERMIT Permit No. ._.___. ------------------ ---- -- ----------------------------- (Complete in Duplicate) -- -- This Permit Expires 9 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 desprbdd. This application. is made in compliance with County Ordinance No. 549, 4-7_ZZQ_ 1•7 25`ce w-7 _jC e L——t s-1— //ff� �i , JOB ADDRESS AND LOCATION_ 0W...e_il ---- ,_• _ _ dH l f ------- Owner's Name -d� -�'o- - � '� ! ---------- ----- Phone------------------------------------ Address '}l b ? eLyx - ------------------- Contractor's Name--,--. t 7 ---------------------------•------------------------ ----------------------- ---- ----- ----- Phone-_------------------------------ Installation will serve: Residence [Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: _- ----- Nu ,ber of bedrooms - - C_Z____ Lot size ---- Number of baths _ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table0 ft. Character of soil to a depth of 3 feet: Sand E] Gravel ❑ Sa Loam E] Clay Loam [❑ Clay Adobe Hardpan ❑ Previous Application Made: (If yes,date-.-------------- ----) No _ New Construction: Yes No ❑ FHA/VA: Yes p;j' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well---'�------Distance from foundafion O- -----------Material--- . No. of compartments.- �--------------Size---�_�( X-.___Liquid depth_----' Qp Disposal Feld: Distance from nearest well_._-.--.-----Distance from foundation----i(Q---- Distance to nearest lot line.--. ...... . Number of lines--rs� ----___-__-Length of each line_ ------_ � 1') Width of trench--------47jeo - Type of filter materiale_71 0 ._(--------Depth of filter material___IK--------------Total length-------- � Seepage -it: Distance to nearest well_-.---- ------Distance from foundation___•./v----------Distance to nearest lQf line__5- Number of prts..�---------------Lining material�b-L�-------Size: Diameter33---�-.---------Deptn-- --•---------------�m Cesspool: Distance from nearest well-----------------Distance from foundation------------.-------Lining material--.-...-------------------__---------. r ❑ Size: Diameter-------------------------------------Depth------------------------------------- ------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----__.____-------------------------------------Distance from nearest building------------------------------..----.--.-. ❑ Distance-to nearest lot line--------IL------- Remodeling and/or repairing,(desciibe):........ ------------- --------------------------------------------------------•-•---------•------------------------------------•-------------- -------------------------------------•-------------------------------------•----------------------------------------------------------------------------------------------------------------------------------- ------------ - ------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- I hereby certify'that I have pared this app' at' n and t t the work will be done in accordance with San Joaquin County 1 ordinances, State laws, and rule nd' ulations a San Jo quip Local Health District. (Signed) ------ --------------------------- - ------------------------------ -------- -------F-------------------(Owner and/or Contractor) 8Y -----------------(Title)-------------------- i (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------------ REVIEWEDBY----------------------------------------- -----------------------------------I- ------- -=------------------------------------ DATE---------=----------- BUILDING PERMIT ISSUED --------------------------- ------------------- DATE---- f Alterations and/or recommendations-------------- ------------ --•------------------------- ------•------------------ --------------------------------------------------------------- ------------------ ---------------------------------- ------------------------------------------------------------------------------------------- •-----------------------•--------- ----------------------- ------------ ---------------------------- ----------------------------------------------- -------------------------- FINAL INSPECTION BY:...--.--.L------------- C( 3 Date------------- --- - ---- -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California N, ,