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FOR OFFICE USE: I'I ------------------- --------- ---------------------- --- ---------------------- ------ --............._--...__:-_____ ------------------ APPLICATION FOR SANITATION PERMIT Permit No. .rz2�. � ------------------------------1 --- --------------------- (Complete in Duplicate) This Permit Expires 1 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. • 40 a g �-' (Ewa ✓ ,�� - �, : JOB ADDRESS AN LOCATIO 3� __ ± .r -►i.�ea _- -t:.� s y ,� -------- Owner's Name C '?� --------------------------------------------- --------------------- Phone------------------------------------ Address / -------------- � -------_-- - Contractor s Name------ -¢- - --- --- Phone---•-----------------------•------- Installation will serve: Residence Apartment House E] Commercial E] Trailer" Court ❑f` Motel ❑ Other C]Number of living units: __I__--- Number of bedrooms y. Number of baths Lot size Water Supply: Public system ElCommunity system E] Private [?�Depth to Water Tablettt-------- ft. , Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [Adobe ❑. -Hardpan ❑ Previous Application cation Made: (If yes,date--..--__-.---_ -) No ❑ New Construction: Yes E] No E] FHA/VA: Yes ❑ No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic ank: Distance from nearest well--- __�-_Distance from foundation i_____-__.Materiai----.-__Ea._._ �.__�_.__.___ ---- No. of compartments_..__�y__-------------5ize-77__V----Y 9..X---___Liquid depth?...._�i� __...__.. Capacity/.20Q.- Disposal Field: Distance from nearest well.__ ---Distance from foundation____/45_./-------bistance to nearest lot line__ --------- Number of lines-----------I----------------------Length of each line-----% A -..---_.!Width of trench.._. -------------------------- Type ..------.------------ Type of filter material-------- of filter material ----i.q____-------±Total lengfh--- _DA--------------_----_--______- O See pa Pit: Distance to nearest well_.---.1106"----Distance from g�foundation___._f.4/------fDistance't o nearest lot line-.S'_-- .__ � r Number of pits.-___.__�"____.._Lining material--- .1!_4 z___-.Size:'Dia meter-__--_._.3-3."___-Depth__.-�S_`_--__-.-.------ Cesspoal::rill Distance from nearest well-----------------Disfance from foundation-----_------ -------Lining material---_..._.-_--_.---.--._-_____------ " ❑ :� ; Size: I]iameter--------------------------- ----------Depth-------------- ------------------------------------Liquid Capacity----------------------------gals. , Privy: Distance from nearest well---------------_-------_-. - _Distance from nearest'buildin -_---.-.---.-. ❑ r Distance to nearest lot line--------------------- Remodeling and/or repairing (describe):------ -------------------------- ----------•-----------------------------••------------------- ----------------------•-------------------------------- 9 , -----•---------- ------------------------------------------------------------------------ -------------------------------------------------------- ---------------- ----------------------------------------------.------ k ------------------------ --------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------ ----------------- --------------------------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------- --- - ------ 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)---------------- ------------ ---- -------------- -------------------------------------------- --------------------� 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---- l' �3 ' _ -------- ----------------- - ------------------ DATE �------------------ �- - REVIEWEDBY----------------------------------------- -- - - ---------------- -------------------- ---------- --------------------------- DATE-- . BUILDINGPERMIT ISSUED---------------------------------- -------------------------------------------------------- --------- DATE--------- --------------------------------------------------- Alterations and/or recommendations--------------------------- ------- --_---------------------------------------------------------- -------------------------- . --------------------------------------------------------• ------------------------------------------------ -------------------------- --------------------------------- = -------------------------------------------------------------------- ------------------------------------------------ •---------------------------- - --------- 1 f , FINAL INSPECTION BY: r 1- ! ----------- Date-/ - 3 7G 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 Tracy,California F.P.CM