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FOR OFFICE USE: r ----------- A r �- APPLICATION FOR SANITATION PERMIT Permit No. :1 �p ------------------ - - ! - (Complete in Duplicate) _!..- --_.-----__. _. This Permit Expires 1 Year From Date Issued Date Issued AL.` , 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. 7,4'JOB ADDRESS AND TION__ _ `-.__1�! _: --/ - -- ----------------------------------- Owner's Namer �� 4_ t --- --- ---------------------------------------- Phone------------------------------------ Address « �c &_%_ -- -------------r------------- Contractor's Name "-' -- ----------------- Phone . _-3---1-.-.-.0-.-.-.-.-.-.--.-.-.-.- Installation will serve: Residence P?"A-partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_!-_- Number of bedrooms ._ _ Number of baths --4- Lot size •_..____� ----________________---------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table-,) ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe O' Hardpan ❑ Previous Application Made: (If yes,date------------- ------) No V New Construction: Yes ;U No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) OF Septic Tank: Distance from nearest well� -`-----Distance from foundation- /4------- .Material--- ------------------------- Liquid ---------------------- No. of compartments___._-_ _-_____-___.Size. rl _ t� Li uid de th__.____ .- `._-_.___Ca acit q P f P Y {• Disposal Field: Distance from nearest well-. _.-._._Distance from foundation../,-----_------Distance to nearest lot line-20........ Number of lines____________-_- - Length of each line____---__-741-___{-____-Width of trench--------.2ff_-___._.._______._ _ .Depth of filter material___ _ __.__..Total length--..... Type of filter material._�t�1G Seepage Pit: Distance to nearest welL_fC1L��-_____Distance m foundation___�Q........Distance to nearest lot line_._,,r__P_._ LR' Number of pits-----/--------------Lining material__ br-Aj�_-_--Size: Diameter-_-- t�.......-----Depth_--_-_' ------------------ Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material-----------_________________________. ❑ Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well--------------------------------------- ---------Distance from nearest building----------.--------------------._____-_. ❑ Distance to nearest lot line------------------ -------------------------------------------------- ------------------------------------------------------- Rem eiing and/or repairing (describe):__-__. --- ---- -------- ----- ----- - -----• ----- ---- - ------ - _'-- ` d ---------- ------------ ------------------ -------•---------------------------------------------------- ------------------------------•------------ - ------- ---------- ------------------- - - 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 rules nd r ulations of the Sin Joaquin Local Health District. (Signed) ,_ c.-LLP, ---------LGC — - -------------------- (Ow er and/or Contractor) BY:------------------------_-_........................ - - ------------------- ----- ----------------.(Title)----/e ' 'r - --- - ........ -- -- ...-- ---- --------- (Plot plan, showing size of lot, location of system in relation to % ells, buildings, etc., can be plaon reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ------ ---------------- -------------------------------- -------------- DATE---------l� -------------------- REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------- ----------------------------- DATE------------- ----------------------------------------------- Alterations and/or recommendations--------------------------------------------------------------------------------------•---------------------------------------•-------------------------------- -------------------------------- ------------------------------------------------------ -------------------------------------------------------------------- ------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------- ------- ------------ ------- --- ------------------ --------------- ---------------------------------------------------------------------------•------------•-•---------------------------------------------------------------- ------------- -------------- ------------------- ------------------------------ ---------------------------------------------------------------------------• FINAL INSPECTION BY:-.---- __._ - _...______...__ Date------- ______fe1#7 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.