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FOR OFFICE USE-r�` i l0 APPLICATION FOR SANITATION PERMIT Permit No. ------------- ------ -- ------- ------- - --- Date Issued ----------------------------- -- - ---� (Complete in Duplicate) <� -------------___--_--____ -__ __ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct an Vile work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION 1_� ------- Owner's Name C .� - - ---------- Phone------------------------------------ 1��:� f Address------- ��-----------------------------------�--"-'-------------------------------------------------------------------------------------------------•----------------------------------- Contractor's Name----------' ! --' `-�-/L1----------------------------------------------------------------- Phone. Installation will serve: Residence gi--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __!r--- Number of bedrooms .92_ Number of baths ._/'`__- Lot size ----9117�_U • - Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table V- - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [ New Construction: Yes ❑ No [7y^FHA/VA: Yes ❑ No ©-^ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: „ Distance from nearest well_________________Distance from foundation--------------------Material-------------------._--_---_______-_--.___-_____- C�6, pllf No. of compartments---------- ---------------Size------•------------------ -----Liquid depth--------------------------Capacity-------------------- Disposal Field;. Distance from nearest well-/ ---- Distance from foundation__ _ _ Distance to nearest Int line___" -------- `<SNumber of lines-------- Length of each line__ ____. _ Width of trench-� _ �y � --------_---- - Type of filter material �,� epth of filter mate Total length__-__-> _________________________ Seepage Pit: -Distance to nearest well-_-f Q -__Distance from foundation--- Q_____-_-Dis.rt�anfe to nearest lot line Number of pits--_/__-_--____Lining material__ ---Size: Diameter_,? -----------Depth-V----' __---_-____-_-_____ 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-------------------- --------'------------ -1------------------------ ------------------------------------------------------------------- A Remodeling and/or repairing (describe)-------------------- -t--------------------------____----------___----------- -------- --------------------- ----------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I ------------------------------- 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 rule and regulations of the San Joaquin Local Health District. (Signed)----------------- -- - ------= � ` - `(Bwor Contractor) By:---------------------------------------------------------------------------- ----- - --------------(Title)--- -f�-='--- -- ---------- (Plot plan, showing size of lot, location of system in re n to wells, buildings, etc., can be placed on reverse side). FOK DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----------------------- - ------------------------------------------------------- DATE------------ _-------------------- REVIEWEDBY--------------------------------------------- --------------------------------- -------------------------------------------•- DATE------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------ -------------- ------------ DATE---------------------------------------------------------- Alterations and/or recommendations:------- 6' _ / c_- Q------------------------------------------------------------------------- ------------------------------- ----------- --------------- --------------------- ----------------------------------------•--------------------------------------------------.......... ------------------- ------------------- -------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------- -------------------------------------1 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------ ------------------ -------------------------------------------------------------------------------------------------------......-------------------------------------------------------------------------------------------------------------- FINAL ------------------------------------------FINAL INSPECTION BY:-------------��-------------------------------------------- Date---------------- .------------------------------------------- SAN --- ----- --------------------------- 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.0 O.