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FOR OFFICE USE: ------------- --------- - APPLICATION I`OR'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 insta4l the work herein described. This application is made in compliance with County Ordinance No.;549, dS " JOB ADDRESS AND LOCATI N---� ----------�l�!'a�-1�----�r..�;��--ea/--------/-'f'l��G.)_----�� `------ Owner's Name --�--------"--. --------------------------------------------------- Phone---------------------------------•-- ll T � --X Address------- °-AA----- --�----- - -_:e_�"-/-,----------------------------------------------------------------•------------------------------------ Contractor's Name--- ----------- `1- -•y" G --- --------- -------------------------------------------------------- Phone------------------•--------------• - �. f I Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/___ Number of bedrooms;>' Number of baths -t-- Lot size __ol-04�+� A-------------------------------- I Water Supply: Public system ❑ Community system ❑11"'Private Depth to Water Table .70 ft. - Character of soil to a depth of 3 feet: Sand ❑ Gravel -""Sandy Loam Ra'*"Ciay Loam [❑ Clay ❑ Adobe ❑ Hardpan ❑ r Previous Application Made: (If yes,date----------- --------) No,RR-" New Construction: Yes E] No UgoFHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewerR is available within 200 feet.) t Septic Tan : e Distance from nearest well-______________ Distance from foundation_____---_----.Materia3:___.______---..____-__--- -___-___.___...____. - r �r .. r t/ No. of compartments------------------------r-Size--------------------------------Liquid depth----------- ;-------------capacity-------------------.-.. I 4 ��el� Distance from nearest well.- Distance from foundation �._______Distance,to nearest I line___ __ ------- Disposal '7r Number of lines__________ ------�___- - -t/Length of each line_______--f.�_______.._-__--Width of trench_/___-_- _-__.____.._--___._ s � e _ 4 Type,of filter material�. ��C�!V_Depth of filter mater3al_._,��___-.Total length____{��r -----.-- Q Seepage Pit: •Distance,to„nearest welL_.__________.i._--Distance from foundation------__------------Distance to nearest lot line----_--.______-._ ❑ Number of pits-----------------------Lining material-----------------------Size: Diameter-----------------------Depth--.--------------------------- Cesspool: Distance from nearest well-----------M�_:_,Distance from foundation--------------------Lining material------------------..__.___.._-_______- ❑ Size: Diameter------------------------- ��--Deoth-------- -------------------- ---------------------Liquid Capacity---.------------------------gals, I Privy: Distance from nearest well---------------------------------------------.--_Distance from nearest building--------------------------___.---------.-. ❑ Distance to nearest lot line---- - ------------------------------- ---------------------------- ------------ ---------------------------- --------------- Remodeling and/or repairing (describe).........I------ -------------------------------------------------------- --:------7------------- --------------------------------------------------------------------------------------•----------------------------------------- ----------------------- ---------------------------- -- --------------------------------------------------------------------------------- -- -------------------------------•------------------------------------------------------------- ---- -----'-------------------------------------------------------------------------------------•------------------ ---------------------- - ---- --- law- 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 r es and regulations of the-San Joaquin Local-Health District. (Signed) ----------- - --- By:------------------.:--------•------------------------------ -------- (fid/or Contractor( t - ------------ ----{Title}-- ..�------- - - -- ------------------ (Plot plan, showing size of lot, location of system i elation to wells, buildings, etc., can be placed on reverse side). { FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED SY------- -- - ---6L-- --------------------------------------------------•----- -------------- ----------------- REVIEWEDBY-------------------------- --------------- ----------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------• DATE--------------------------------------------------------- Alterationsand/or recommendations-------- --------------------11 -- ------------------•-------------------- -------- -----------•-----------------------------•-- ----------------------------- ' -------------------------------------------------------------------•----------------------------- ------------------------------------------------------------------------- ------------------ -----------------------------------•------------- --- --- ----------- ------------------------------------------------------------------------------------------- ---------------------------- --------------------------------------------------- ------------------------------------- --------------------------------------------------------------- --- ----------•-------------------------------- - ---------------------•----- ------- ----------------------- ------•--- ---------------- ------------------- ---------------------- FINAL INSPECTION BY:... - - ----------- Date .r�L ��c� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street f 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California -r'F.R C O.