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FOR OFFICE USE: 118' -- ----------------------_------------------- '� APPLICATION FOR SANITATION PERMIT Permit No. _ _. _.._.__.._ -------------------------- - A--------------- (Complete in Duplicate) 6 /�} � Date Issued __ _1±._./-�__--_.__--- _-_-_-_._ -_I/� -__-----_.-_ 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 compncV.. ' County a0urdina No 549. JOB ADDRESS AND LO TION- --- __--. --- - -- Owner's Name-_- --(/fir .................... Address -------------------------- Phone......................... ( --- --------- Contractor's Name--- --- •• - ----•----------------•--- --------------------- ---,------------------------............ Phone................................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El 01 Number of living units: _ _. Number of bedrooms __'Number of baths ��ot size /.10._,�..1-w-�-_--------------- Water Supply: Public system ❑ Community system ❑ Private V?`6epth to Water Table 49�ft. 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 R?--New Construction: Yes M-*"N-o ❑ 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--s��___-__Distance Jom fo ndation__-�©_:-._-.Maaterial---C.l__�- f' _ ._._.__.. No. of compartments_-,�,;___.__--_._-SizeJ�— quid depth__'7`'-..--------...---Capacity_4*27®,49___ Disposal Field: Distance from nearest well.- a'f__.-_Distance from foundation... r2•___---.Distance to nearest lot line._ ------ ®/t Number of lines-------02-___ �ength of each line---l -------------------Width of trench-A-----___-__.-_---.-._--_-_ 1115, Type of filter mate ria 11z&,e - Depth of filter material__/�___-_-------Total length__�_r�___---------------------- i Seepage Pit: Distance to nearest well-_,,-"40-0-. Distance fr fou ation_______4--------Distanyce to nearest lot line-J'. ®� Number of pits----A-------------Lining material... ©G ize: Diameter._3'2.------- ---Dep#h_40_ ` Cesspool: Distance from nearest well-----------------Distance from foundation___-__ Lining material_____ ___________---.--.-_-__-___ Size: Diameter-------------------------------------De th----------------------------r---------------------Liquid Capacity gals. 37 11 Privy: Distance#ream-nearest wed=-.- - - -- Distance from--neares#-building—..._.------------------------------- ❑ Distarice"to nearest lot line----------------------------------------------------------------------I------ --- -------- ----- ---- -------------- ------ Remodeling and/or repairing (describe)--------- - ------ ---- -- -------- --------------------------------------------------•--- ------------------------------------------------------=---- == - ----------------------------------------------------------------------------------------------------------------------------------------------G ----------------------------- --------------- ------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------ 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 pules and regulations of the San Joaquin Local Health District. (Signed)------ ------ - --- -- ------`- ---- ------- -- ------------------- ------ -------------------------------------(Osv df or Contractor) B ------------------------------------------- - -Title.... - ------------- �P,%�IF„ Y• ( ) � (Plot plan, showing size of lot, location of systems in relat' to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--.------ _-_... - . �'� - - - - -----c�'�'-'-....�--------------------------------------- DATE--------�----•------ -�------��---------------- REVIEWEDBY------------------------------------ ------- -- -------------------------------------------------------- DATE-------- --------------------------------------------------- BUILDING:-PERMIT ISSUED----- -------------------------------------------------- -------------- -- DATE------------------------------------- ---------------------- Alterations'and or -__--.------------ * T=,,,f ----- -----•-•-- --•-------------------•- ------- -----------------------------------------------------------------------------------------I-_--__-_______---_._._--_---_--____.-___-_-___--_-------_---_--------_----__---__----_.-----_I------..__.._._-.___.----------------- ----------- ----_---_---------------___.-----------_-_--.----._.----------------_-__-_---_-_---_--------------.------_---_____--__..•._.-_-_--_.--------.-----•___-_----•---.---_----.-_-__----._-_-----___---__------_---.-.---------------------- FINAL _-._--_---_-•------.- 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.C C.