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FOROFFICE USE: ---------------------------------------- - -------------- p ___________________________-..-_-_._--.-..-..___.-_---- APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------------------------- (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. S49_ JOB ADDRESS AND LOCATION � - - :-- -- e�. c- F-, uR« C.A ,-,T-- rx•. Owner's Name___- ------tv--- -- ------ -------------------------- ------ -------- - ------------------- ---- -- ------ Phone------- ----- --------------- ------ Address----------- -------------- Contractor's Name---- ----TA ----- ------- -------- ---- -------- ------------------------ Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __r-- Number of bedrooms ___ Number of baths __ ot size ------------------------------------------------------------ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam e Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: [If yes,date_________ _________ ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , Septic�T�nk: Distance from nearest well--_-�G..r-----Distance from foundation..._AP-__.-----.Material.--. ------ "4 ----- Q p - t� r/, �_X!7r Liquid.depth-------44-.--- --- ----Capacity-----� � %1''" No. of compartments I/ - Dispos Field: Distance from nearest well__.___r.._Distance from foundation......j0_/-_._..Distance to nearest lot lineS............ Number of lines----------�-----------------Length of each line---?Z_7JY_''_-_3V'.Width of french---:2-_"-____-_--_.--..--_------ 0 Type of filter material-------- -----Depth of fifer material....)F_f'.____...Total length------- Ak_`----------------------- 0 Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance to nearest lot line----------------- 11 Number of pits------------------ ---Lining material------------=-------.- Size: Diameter.---------------- -----Depth------.----------------------_--- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material..______--._.._._-__----_------__.-_- ❑ Size: Diameter- ----------Depth- -- --------------------------- ----------------Liquid Capacity----------------------------gals p� Privy: Distance from nearest well----------------------------------------------- Distance from nearesf building----------._-.______________.__._.____._- C �, ❑ Distance to nearest lot line- --- --- ------------------ ---- - - - - ----------------------- -------------------- Remodelingand/or repairing (describe):----- - ---------------------------------------------------------------------------------------- -------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------•----------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------------------------------------------- ------- ----------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la and rules and regulations of the San Joaquin Local Health District. (Signed)--------------- -- =--------- ---- 9 -1 ------------------------------- { r and/or Contractor) ------------ - --- -------- - By:._..._.. - ---------------(Title)-------------------------------- — -- (Plot plan, showing size of lot, location of system in re ation to Its, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY....... DATE `" . REVIEWEDBY--------------------------------------------- --------------------------------------------- --------------------------------- DATE------------------------ BUILDING PERMIT ISSUED------------- ------------------- --------------------- ------ DATE------------------------------- ----------------------- Alterationsand/or r1commendations--------------•-------------- ------------------------------------ ------------------------------------------------------------------- ------------------------- --------------------------------------------------------------•------------------------------------- ------------------------------------------------------------------------------------------------------------------------- ------------------------ ------------ -- -- ---------------------------------------------------------------------------------------------------------------------------------------------------------- ---- ---------------- FINAL INSPECTION BY.-.- -- �--- r --------- Date___....----'----'--------------------- y s•.. Q.. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.