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FOR OFFICE USE: , APPLICATION FOR SANITATION PERMIT Permit No. .a�_...�.-�?..�� ________________ (Complete in Duplicate) ... ... 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 compliancy with Coun'ty-�Ordinan No. 549. ^ JOB ADDRESS ADDRESS A LOCATION / L!<. % /'- ----- ---Ket~ -�"`�'� 0 Owner's Name --•-- ----- ------ Phone iii ---------------------- Contractor's Name ---- ----------------- ----- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [I Number of living units: _/--_- Number of bedrooms -/---_ Number o baths I--- Lot size _--- ------•-------•-------- Water Supply: Public system E] Community system [_1 Private epth to Water Table ---_--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 0 Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-----------_--------) No ❑ New Construction: Yes ❑ No ❑ 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-----------------Distance from foundation__---_-.._____------Material-----------._...--------------------------------- ❑ No. of compartments-------------------------Size------------------------ ---Liquid depth-------------------------Capacity................----•-- Disposal Field: Distance from nearest well-----------------Distance from foundation....................Distance to nearest lot line__--____--_-_-__ ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench--_-_--_----.- _-----__--___----- Type of filter material-------------------------Depth of filter material-----------------------Total length_-:.-------___-_-....._____._________.__._ t See a Pit: Distance to nearest well..---1_'0o__`----Distance from foundation-__ .__.._..Distance to nearest lot line�.�._....... g T� r-- - - P Number of pits-------- -----------Lining material__:..__�__. _ Size: Diameter__...__�t� _.____De th___..�--�'___________________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------.----------_---------.--__.---_. ❑ Size: Diameter------ -------------------------------Depth----------------------.---------------------------.-Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building------------------------------------------ 171 ----- __-____.----__-_---_------_-.-.❑ 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 d rules and regulations of the San Joaquin Local Health District. (Signed)___ ' 9 _e,� --_---_-Asim and/or Contractor) By: ------------- - (rifle).-. - -- -- (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.. r:.y N ------ DATE__/-�=..� _ REVIEWEDBY-------------------------------------------------- - DATE--------- ----------------------I PERMITISSUED---------------------------------------------- -------------------------------------------------- DATE-----------------•------------------------------------------ Alterationsand/or recommendations:-------------------------- -------------- ----------------------------------------------------•-----------------------------------------------------...------. .� f' f ---- ------------- -- -- -- ---------------------------= = - ------------------------------------- � ----------------s� -------------------------I---------'-----_•---- NES- ----ove-------- /_ 7=4,4� - FINAL INSPECTION BY:. `'/ �.� Date .. ----------- ----- I - 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.0 C.