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FOR OFFICE USE: v \ ---------------------------------I------------ -------........---_.-_. ,.►-_---.-________-________-_- APPLICATION FOR SANITATION PERMIT Permft*Jo. W ------------------ --'}-- t (Complete in Duplicate) ---`-�---�� -L--S This Permit Expires 1 Year From Date Issued 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--- 'Z' o�-- �L��.------------------------------ ----------------------------------------------------------------_-------- * r � Owner's Name---0-- --- -•-------yla. w0---------------------- -------------------- ------------------------------------- Phone------------------------------------ Address--------- - ----c --- --- Contractor's Name -- ------------_-- ---T---_S --------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence U�partment House(0--coJmmercial ❑ Trailer Court C] Motel ❑ Other E]Number of living units: ._.___ Number of bedrooms .�- Number of baths __/___ Lot size ...... _ax_I.-_p______________________________ Water Supply: Public system Community system E] Private E] Depth to Water Table .*//bft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe gi—Mardpan ❑ Previous Application Made: (If yes,date---------_..------ ) No 21" New Construction: Yes En�'No ❑ FHA/VA: Yes ❑ No 29— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Sept'T nk: Distance from nearest well__—_-------Distance from fouqndation_/#-------------Mat al.___C____040- -__ No. of compartments____: -______________Size..;__�.f___x__/__:_--Liquid depth__-____ _._.._-_._-____Capacity___7�0 e Disposal Field: Distance from nearest well- -_-_._Distance from foundation-A3 _I_______-Distance to nearest lot line."_'.... Number of lines,_j-�__;-�--__-_-_____-_____Length of each line--t5-0--- f-00__-Width of trench'ZI_'•-------------___--__- Type of filter mate rial�Q__C_AC___-.__Depth of filter material___ ---------------Total length-----�it5'Q_.-________________ Seepage Pit: Distance to nearest well----.—-----------Distance from foundation---LA---_r.-------Distance to nearest lot line----4`------ _---EET--- •--- Number of pits-_-A—------- __Lining material---To cR-/r-----Size: Diameter--_- Depth_-_.�.c -----____-___.... 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-- --- --------------------------- --------- -----------------•--•-•--------------------------------------------------._------------------- Remodeling and/or repairing (describe):------------- --------------------------------------•-----•---------------------------------------------------------------------------•-•-----•----- --_--•-----•-•-------------------------•---•----------------------------------------------------------•-----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 rules and re lations 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 APPLICATION ACCEPTED BY--------- ---- -------------------------------------------------- DATE----- — _ 5-------------------------- REVIEWED BY-------------------------- -------------------------------------------------- --- ---------------------------------- DATE-------------------------------------------------- - >ABUILDING PERMIT ISSUED----------- ------ ------- ---- ---------- Alterations and/or recommendations: _ ---------------------------- --------- _--------- ----------- --- .... ------- ---------------- ---------•---- ---------------------�---�-----------------------------. ------------------ ----------------- ------------------ ------- -------------------------------------•--- FINAL INSPECTION BY:-.--- __- ------ - _-,------_u�-------------- ---------- _ 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