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FOR OFFICE USE: r APPLICATION FOR-SANITATION PERMIT Permit No.a-_..................... --------------------}- - -------------- (Complete in Duplicate) " � Date Issued -.._..__-:-___--__..................._-_._-...._-. 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 compliance with County Ordinance ��No. �549. JOB ADDRESS AND LOCATION. rv/ 17_--�---�'t"�-:------------------- ---------------------------------------................................................ Owner's Name.----- ------ - - -•--------•-•----------------•-------------------- -- Phone------------------------------------ Address------------7. ----•---•---------------•-----•---.Address------------7. Contractor's Name- J - C(\� -t- ��------------------------------------------------------------------------------------------- Phone-------------------....-•---------- Installation will serve: Residence ®/Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -----/_ Number of bedrooms _..L-Number of baths 1----.. Lot size ..7_a7_A_1,� --------------------------------- Water Supply: Public system D-Community system ❑ Private ❑ Depth to Water Table J�:VKft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E3--'Hardpan ❑ Previous Application Made: (If yes,date.------_ ---------_) No F!r New Construction: Yes ❑ No 1!1" FHA/VA: Yes ❑ No}7 TYPE OF INSTALLATION AND SPECIFICATIONS:._ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept' ank: Distance from nearest well-----------------Distance from foundation-------------------.Material-------------- -----_------_.._._.----...._--. No. of compartments----- --------------------Size-.----•------------------------Liquid depth--------------------------Capacity-------------- ------ Disposal Fi d Distance from nearest well-----------Distance from foundation-_.!�?..........Distance to nearest lot lines.......... Number of lines.-..-_-./-.-_-_-__.._.--_.---Length of each line.A©_'_-------------_...Width of trench/._ :t..'.0-- ._....-- Type of filter material- __ pL -._-Depth of filter material---/_$----_-------Total length----fes- -'................_...__.. Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-..-------_-.---- ►� ❑ Number of pits------------------._.Lining material----------_------------Size: Diameter-----------------------Depth_._---.-----._-_--..--....... � Cesspool: Distance from nearest well-----------------Distance from foundation.-------------------Lining material---------------.__--.-._._-.-.-.-- ❑ Size: Diameter_----------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. tN 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 prep d this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules an egulafions of the San ui2>ocal 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------- �-a 454 ---------------- --- - - REVIEWEDBY-------------------------- -------------------------------------------------------------------------------------------------- DATE------ ----------------------------------------------------- BUILDING PERMIT ISSUED---------------------------- --------- ---------I-------- ---- DATE- ------- Alterations and/or recommendations:------- --- . l- . t:....... C ------ ---- ------ ---------------------- ------ -------------- f--------------------- --------------- ------------------------------------------ ---- p - _ • ------ ------11:1 i 2o -------------------------------------- - ------------------------- . =- --- ---- ----- 10 FINAL INSPECTION BY:.... Date---- - ---------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.RCO.