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oe FQR OFFICE USE: ___- v_------- APPLICATION FOR SANITATION PERMIT Permit No. .. (k to (Complete in Duplicate) �� 1 _._.__ 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 wor herein cr ed. This application is made in compliance with County Ordinance No. 549. UI JOB ADDRESS AND LOCATION. �_ '_.�_ cer.�? 15e4 � Owner's ------- - -- --------------------------------------- Phone------------------------------------ --------------------------------------------------------------------------------------------- ............ .......... - Contractor's Name--------------------'--- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __t---- Number of bedrooms ---3- Number of baths _1_--_ Lot size ----- x1 .4?-------------------------------- Water Supply: Public system ❑ Community system ❑ Private [7J--Depth to Water Table ---401t. Character of soil to a depth of 3 feet: So(nd ❑ Gravel E] Sandy Loam E] Clay Loam E] Clay [-] Adobe ardpan ❑ Previous Application Made: (if yes,date/--_-..------------) No [!T�New Construction: Yes 29--1Qo ❑ FHA/VA: Yes ❑ No al— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic T Distance from nearest well____..__Distance from foundation---�!?..r....._...Material-----�° �................ No. of compartments-.2------- ------------Size__--_- `__5 x_. __.___Liquid depth------- -------------Capacity... Disposal Distance from nearest well_SS..O------Distance from foundation---/-.9--__.......Distance to nearest lot line-�__-__:._._.. Number of lines__..�--------------------------Length of each line---7r-------------------Width of trench..- Y---------._-.-._-__--.- Type of filter material7l?b.4't----------Depth of filter material---t_i(--------------Total length------- --.--________________ Seepage Pit: Distance to nearest well-1410-----_____Distance f�ro foundation----- Distance to nearest lot line-077!------ (dumber of pits--_.2--____-.------Lining material------/r4_C-L(.Size: Diameter----J3.'.r--------Depth---------v2.j--.,I----_-.- Cesspool: Distance from nearest well----------.------Distance from foundation-------._--.--------Lining material--------------.-_-_----------------. ❑ Size: Diameter--------------------------------------Depth--------- ---------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well _-_---______-._..-----------------------------Distance from nearest building----- ----------------------------- ...... ❑ 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 I s, and rules and eg tions of the San Joaquin Local Health District. (Signed)--------- -=----- --------------- -----------------------------------------------------------------------------------------(Owner 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 ATION ACCEPTED BY .. ------ ` ----------------------------------- DATE------/ -17/� - --4-------------------- ED ------------- ---ED BY------------------------------------------ -- --- ----- - -- --- ------ --- ----------------- ----------------• DATE------------------------------------------------------ ----- BUILDING PERMIT ISSUED----------- -- , ---- ,----- -DATE _1"--- -----------------S_ Alterations and/or recommendations / ._ ._ _...____ � t C �- 1 - =�' �• --- -------------------- --1--------------------------------------------------------------------------- -------- ----•----------------------------•------------------------------•-------------------------- ------------------------------•--- ------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------- FINAL INSPECTION BY-.---.- - ------------ Date---------------------------- 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.CO.