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FOR OFFICE USE: �1- z APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------------- ------------- -------------- ------ -- -�-------- (Complete in Duplicate) Date Issued -------------- ------------.-_. This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. This application is made.in compliance-with_County Ordinance No..549_.,- JOB ADDRESS A LOCA ION---- 33----_---E ! . t+3J - ----------------------------------------------------------- Owner's NamePhone_ - _% ----------------------------------------------------- ----------- ---- ----- - Address �� 1_- .. - =-----------------------------• ----_--------------- ----------- - = '_..... `� - Phone.�� ContractorsName_----=- ••--------- - ------------------ --------- ------------ -----------------•----------•--- } Instaliation will serve: Residence House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _�---- Number of bedrooms�--- Number of baths _e---- Lot size __�..?. - ._.0ri�_----__________________.----.- 1 Water Supply:'•'Public,system Community system ElPrivafe ❑ Depth to Water Table €t. I Character of soil to a depth of 3 feet: Sand ❑ Gravel.❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe� Hardpan ❑ I Previous Application Made:. Ilf yes,date----.------:--------.) No F71 New Construction: Yes El No FHA/VA: Yes ❑ No ❑.; TYPE OF INSTALLATION AND SPECIFICATIONS: (No'septic tank or cesspool permitted if public sewer is available within 200 feet.) 7 Septic Tank: . Distance from nearest'i well-40-4J/>_-Distance from foundation--.} __...-._-Matenal..-'_________________________ __. +Ci/lrEr "Nor.:oficompartmen•ts:------- F'-----------Size-------------------------------Liquid depth---------- ----- ---------Capacity----------------------- ' Disposal Field: Distance from nearest well_,_-_......____Distance from foundation_. _`_____.Distance to nearest lot I�5e___/ Number of lines.--.--------t-------Y-=------'_Length of each,line----------------�---------_--Width of trench---�..�_,-.------------------ „ „ � yp Ph.t -_-X�De;ptkh of filter material-_i�_.-._-_--.---Tota4 length----3G----------------------.-------- SeepagePit: Distance' to nearest well- - ---Distaryce to nearest lot line_ -�__... T �e of'filter material- _S° / �/g{ _...___Distance from foundation__t'_e _____.- j 3.3--- --------Depth--2--`Y- Number of pits_._.__.____`.-�:--Lining materia�llG-�__.__--.Size: Diameter--- Cesspool: Distance from nearest well ---------------Distance from foundation.................._Lining material___---_:_r_----...__..___-- W .Depth-------- -----•------------------------------------Liquid Capacity--------------------.--------gals. ❑ Size: Diameter------- - - --- - ----° -- ---_-------------Distance from nearest building W Privy: Distance from nearest well-----------------------_____. 9 ❑ Distance to nearest lot line-.---- -- ---•-------------------- ------------------------------------------------••-------------------- Remodeling and/or repairing (describe}: -------- --------- ----------•--•------ -----✓--------•----------------------------------------•--------------------------- ------ ------------------------------------------- 2-------- -------------------------------------------------------------------------- - --------------------------------------------------------------- `.t------------------------•-- - ------------------ ---------------------------- ----------------------- 1-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 jLocal Health District.--- ---- [Signed----------��- _ rx '----=------------ ---------------------- ----------------------- -- ---------------------------------- ------(Owner and/or Contractor) I I Y: -- ----- ---- - ------- Title------- ------ --------------- {Plot plan, s wing size of Eot, 10 ation of system in relation to wells, buildings,,etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------------ DATE-------- ' -' ---------------- ------------- -------------------------------- - DATE -- REVIEWED BY-------------------------------- - -------------------------------- -- BUILDING PERMIT ISSUED--------= --------------------------------------- ----- DATE Iterations and/o e m endat'ons:_--. ----------------- - - ------•---------------------------------------•------------..-..-•----------- -o- ' J�-------------- ------ ------ ---------- -------------------------------------------- ------ ------------------------- r FINAL INSPECTION BY:..--- ----- ----------------------- ------------- Date ��` = ' r SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantecar California Tracy,California F.P.CO.