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FOR OFFICE USE: _ - -- -:--- �----- --------- _____________..____._______._______ R APPLICATIdN FOR SANITATION PERMIT Permit No. ...lr.`��........ (Complete in Duplicate) -7 ------------ ---- - -� �'y /(``' 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. JOB ADDRESS AND LOCATION ___ _.__ L/ --------------------------------------------------------------------------------------------------------- Owner's Name--- ---------- -------------------------------------------------------------------------------------- ------------ Phone-------------------•--------------- Address --------- --------------------------------- Contractor's Name-- =� ------------------------------------------------------------------------------------------------------ Phone----------------------------------- Installation will serve: Residence (=j Apartment House ❑ Commercial ❑ Trailer Court [g''Ivlotel ❑ Other ❑ Number of living units: Number of bedrooms 7L'__- Number of baths _11'___ Lot size ____l�"� ------------------------------------------ Water Supply: Public system []'Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ y Loam ❑ Clay Loam ❑ Clay ❑ Adobe [n''Rardpan ❑ Previous Application Made: (If yes,date-------------._-----) No New Construction: Yes E] No ET FHA/VA: Yes [:1No E7-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept' Tan _ Distance from nearest well_________________Distance from foundation--------------------Material__----.--___---__-_-----_---_:__--._.__-_._-__-_. No. of compartments--------------------------Size-----•-------------------------Liquid depth--------------------------Capacity---••---------------•-- �- Disposal Fi Distance from nearest well.___ ---------Distance from foundation.. D --------Distance to nearest lot line.-__13-------_--. Number of lines ___.._--__Length of each line_ ❑ 9 �-•r-------------------Width of trench-�.1`_`---�-•----------------- ----------- Type of filter material _?aG/(------.---Depth of filter material_/8__ ____.____Total length---- '*j" Seepage Pit: Distance to nearest well____.—--------------Distances{rom foundation--/e------------Distanke to nearest lot line__._/--___._ v Number of pits_.-----_____________Lining materialC---1(MIC------Size: Diameter------ .! .___.-----Depth___ _ ________________ Cesspool: Distance from nearest well--------------___Distance from foundation--------------------Lining material-------------------------------------- 171 Size: Diameter--------------------------------------Depth----------------•----------------------------------Liquid Capacity----------------- ----------gals. Privy: Distance from nearest well--------------------------------------------_____Distance from nearest building____________-___-___---.--___._.__-- ❑ Distance to nearest lot line------ ---------------------------------------------------------------------------------------------------------------------- ----------- Remodeling and/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 laws ules 71, r gulati ns 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 I APPLICATION ACCEPTED BY..... - .! �------------------------------------------------•--------------------- DATE-------.3h-fid : c ----------------- REVIEWED BY---------------------------------------- ---- --------------..... DATE------------------------------------------------ ---- --- ---------------------- ---------------------• --------- BUILDINGPERMIT ISSUED-------------------------------- --------------------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or r comrgendations:__..___.____________________________._ .._x___________________ ------------ ,wl-_--- e-4 o ,`r « •----- ---------- -------•---------•--•---------•-- .W , ----------- ---------------------------- ----------------------------------- ------ FINAL INSPECTION BY:--------------t�._�_--------------- -------------------- Date-------`�-_�� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street k Stockton,California Lodi,California Manteca,California Tracy,California