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FOR OFFI(]&S'Ei'i'' -------------11,--lez-XI�rV�4 14a /--_9---------- ------ APPLICATION FOR SANITATION PERMIT Permit No. tD) - -------------- ----- -------------- (Complete in Duplicate) Date Issued --------------------- -------------------- This Permit Expires I Year From Date Issued Application is hereby made to the San Jop� iri—Local_Health—District for a permit to construct and install the work herein described. This application is made in complian with2f,)ty rdin%c�l 549. 01*4 ------------------------------------------- JOB ADDRESS AND �OCATION.41 ---------------------------- Owner's Name------_- ......6------- - -- ------------------------- ------ ----- Phone................................. ...................... -- ---------------------------------------------------------------------- ---------------------------------- ------------------------------------------ Phone................................... Address ---------------//- - ic,--2.1 Contractor's Name-------------- Installation will serve: Residence Ek'-Apartment House E] Commercial E] Trailer Court E] Motel [] Other E] Number of living units: ___/__ Number of bedrooms ;j--- Number of baths /---- Lot size -----------------_---------- Water Supply: Public.system B--c-ommunity system [] Private Ej Depth to Water Table /1:2 ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam El Clay Loam El Clay E] Adobe Q__qardpan 171 Previous Application Made: (I.Lyes,date-�///��/��`t,/-f--) No E] New Construction: Yes P'No 0 FHA/VA: Yes g---No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available,within 200 fequ. Septic Tank: Distance from nearest -- well_---:=------Distance from foundation--- 1(i------ -------------------- --------- No. of compartments__ ----_-.__Size„?X -X_�&/--- Liquid depth--- - Capacity...:f�Z�4:______ Disposal ------- Disposal Field: Distance from nearest well.___----_____- Distance from foundat_io_n____//f---*------Distance to nearest lot linea?------------ ET-_ Number of lines__________---- Length of each line__,l/........... - -------Width of trench.,__�,._,------------------------- Type of filter material ;/_"`/� 4 Depth of filter material-Z)-(-------------Total lefigth---, �_------------------------ Seepage Pit: Distance to nearest well--------------___.-___Distance fl;pm foundation---/j_--------Distance to nearest lot line-- e I....... 0 Number of pits----/------- ------Lining material__/f�, Zze-----Size: Diameter_.u3_ ----------Depth_4�2:�,_/,�( 0 Cesspool: Distance from nearest well-----------------Distance from foundation------------------.1ining material-_____________________________-___-_ Tf1 ❑ Size: aterial------------------------------------ Size: Diameter--------------------------------------Depth--------------------------------- ------------------Liquid Capacity--------=----•------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_.___-____-.-.___.___._-__-_---_-___-_. ❑ Distance uilding-------------- -------------------------- 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, and yr�les ,�l e d regulations of the San Joaquin Local Health District. (Signed)------------------------ .4------ ------------------------ Pwne"ftd/or Contractor) --•Y-- --------------ffitle)__ --------------------------------------------- By:------------------------------------------------------------------ -- ------ ----------- ---- ---- --------- (Plot plan, showing size of lot, location of system in r o a ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ol �,Sol APPLICATION ACCEPTED BY-------- ------ --------------- ------------------------------------------- DATE------ ------------------------------ REVIEWEDBY-----------------------------------------------_ ----------------------------------------------------------------------.... DATE--------------------- ---------------------------------- BUILDINGPERMIT ISSUED---_------------_--------------------------------------------------------------------------------- DATE---------------------------------------------------------- �te�r ;V Areommendations:-------------------- r-------------------------------------------------------------------------------------------------------------------------- _�ions,; ..... - - .-A ------ --------- -------------------------------------- --------------------I------------------------------------------------- -------------- 4, ---------- IF , .0o? ;R""--- ------------------- --------------- ---------------- ------------------------- ----------------------------------------- ------------------------------ ......... ------------------------------------------------------------- ----------------------------------------------- ------- ----------- ---------------------------- ----- ---------------------------I--------------------------------------------------- ----------------- ------------ ------------- --------------------- ------ ------------- FINAL INSPECTION BY:.. s---- ---------------------------------------------- Date- 17 --------6,71_ez; -------- ------- --------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hax*lfon Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.120.