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FOR OFFICE USE: 7 - -------- -------------- / ------------ 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 described. This application is made in compliance.with..County Ordinance No. 549, if -2� l z. JOB ADDRESS A LOCATIODQ.- - !`� �� ,,�-t -,fid-------- -------- Owner's Name.-146 t --- _ ------------------- -------------------- Phone - �[J ---•- ------•----••----- �''�-, i 1 Address----- --�----- -------- ---- - -----•-------• u � q Phone-_--•---------------•------------ Contractor's Name_ --' -------- .- = Installation will serve: Residence7'- Apart ent House F-1Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ N W k Number of living units: --�-_--!Number of bedrooms-.---- Number o baths -f-._ Lot size - Lt- ---• .. _ .. _ .. Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -_-- t. Character of soil to a depth of 3 feet: Sar4d ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay, obe ❑ Hardpan [� fi y Previous Application- v:------- .-.-•} rNo ❑ New Construction: Yes ❑- No ❑ FHA/VA: Yes ❑ No 1771Made- (if yes;date TYPE OF INSTALLATION AND SPECIFICATIONS: . -.— �• —-- -(No septic.tank of ce"sspoo`I permitted-if-Vuublic sewer is available within 200 feef.] Septic Tank: Distance from nearest well-__------_-.---_Distance from foundation---------------_.-Material---.--_----.__-_..- _-.:__-_---- ❑ No. of compartments-------------- ----------Size---- -----•-•-Liquid,depth----------- -------------.CapadtY IF Disposa field: Distance from nearest well----. a_!.-_Distance from foundation.---/0-.-------Distance to nearest lot line__= --..------ Number of lines-----------1------- - ---Length of each line-------/.a-u...--__-----Width of trench..Z------------------------------ �'7 ...... Type of filter material--------dZ ----Depth of filter mater al-.-.__J�h - --Total length----ja 0----------------------------- 1 See it: Distance to nearest well----/-PU-------Distance from foundation-__-----�_-.--_.Distance to nearest lot line-.- ------ �� ' _3..�.----Depth---:Z S.°---------------- Number of pits---------- --Lining material.-----._--:�_ -.---Size: Diameter-----3 Dista}ncerfrom nearest well-__- -_._--Distance from foundation--------------------Lining material--.-------.-------- ---------- als. 171 Size: Diameter------------------ - --------------Depth------------------------------------------------ .Liquid Capacity g �~ ----------------Distance from nearest building t.,'Privy: Distance #rom nearest well--------•-----------=---- ----- ❑ -------------------------- Distance to nearest lot-line------------------ '-;------- --------------------------------------- - ------------• ------- ------------------ Remodeling and/or repairing (de A--- -----••----------------- - 15 t I-. � _------------------------------------------------------------------------------------------------------------ -------------------------------- ---- -------- - - ----------------------------------------------- I hereby certify that have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law an rules and.regu •ons of the San Joaquin Local Health District. -• _.. —� ------•------------------ er�.and/or_Contractor.j_.�, Si Wed —• - - -----------= •------------------ - -- - ------( i+a)--------- ------------------ --------- ------ - ................ (Plot plan, showing size of lot, location of system in relation.,to wells, buildings, etc., can be placed on reverse side). ' 3 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------------------- DATE-. --- i DATE---------- -------- ------------------- ------------------ REVIEWEDBY--- -------------------------------------- ---- ------ ---------------------- - --- ------- -------------- -------- BUILDING PERMIT ISSUED__------------------------ ------------------- ------------- ------ ------- - DATE------------------------------------------------------------ Alterations and/or recommendations:--------------_-- --------------------•--------------•--------•-----------•-------------•------------- -------------------------- -------------------- Date_A.._ (a_-`b--- ---------------- -----------•---------------------- FINAL INSPECTION BY:- 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 r.a.c n.