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FOR OFFICE USE: own --------------------------------------------------------- -------- ------ APPLICATION FOR SANITATION PERMIT Permit No. -----------4 ---------- ---- ------- (Complete in Duplicate) ----------------- -------------------- -------__. I 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 A D LPCATION..... Owner's Nam:--. e- ----:Z ---------- --------------------------------------------------------------------V --------- Phone W Address......... ......... ---------------------------------I-------------------------------------------------------------------------------------------------------------------------- Contractor's Name_ J�------------- ----7--s -----. Phone.-----------------------------..... Installation will serve: Residence ❑—Apartment House El Commercial Ej Trailer Court E] Motel E] Other E] Number of living units: _1__.-- Number of bedrooms Number of baths _l_.___ Lot size Water Supply: Public system I Community system Private [Depth to Water Table ---Z F E] at, Character of soil to a depth of 3 feet: Sand [] Gravel Ej Sandy Loam F] Clay Loam [:] Clay F I Adobe El"kardpan 0 Previous Application Made: (if yes,date--------- --- No [J,--'New Construction: Yes E-] No ffFHA/VA: Yes 0 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se Distance from nearest well_________________Distance from foundation--------- ----------Material No. of compartments------------- -----------Size ---Liquid depth------------- -------Capacity----------------------- Disposal Fialdy, Distance from nearest well--47'0---f__Distance from foundation__jg!�_.r--------Distance to nearest lot line-_`d- 0 Jejo�"�f Number of lines..__f----------------------------Length of each line------;30_*---------------Width of french-----,- Type of filter materiai__7/A_C/�":------Depth of filter material---IJ---------------Total length---___- ------------- K i? Seepage Pit: Distance to nearest ,,ell,- .__--_Distance from foundation----60-__._--.Distance to nearest lot line---47�-- - ---- �� Number of pits-------/-----_ _-Lining material-----Wc-,jClf__.Size: Diameter----- 3_i�- --------Depth-.__947- --_-_- ---- Cesspool: epth-----2947-- ------- ---- Cesspool: Distance from nearest well___--_._.--___Distance from foundation--------------------Lining material R Size: Diameter. --- ---------- -- ----------------Depth------------ - --- - ------------------------------------- Privy: Distance from nearest well______________________ - -------------------------------Liquid Capacity---------------------------gals. gals. ----- ❑ Distance to nearest lot line----- --- ----- .___-Distance from nearest building-__.._-__-_---------------------_---_- .. ......... .........................---------------------------------------------------------------------- Remodelingand/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 rules an re ulafion of the San Joaquin Local Health District. op ----------------- - (Signed).. _C -------------------------------------- --------------------------------- ------------------(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_-__-_.__-_ -.__z-..r-------- ------------------------------- -------------------------------- DATE-- REVIEWED BY------------------------------------- --------/� BUILDINGPERMIT ISSUED---- -- ------------------------------------------------------ --------------------------------- DATE------_--------------------------------------------------- ------------ ----------------- DATE----------------------------- -Alterations and/or recommendations:----- i, - _ - � ��n------------------------------------------------------------------------------------- -----------------------------------------------------------I---------------------------------------------I---------------------------- ------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------ -------------- ------------------------------------------------------------------------------------- ------------------------------------- ----------- -------------------------------------------------------------------------------------- ------------------- --------------------------- ------------------------------ ---------I---------------- ----------------- -----------------------------I---- ------------ --_------------------------- -------------------I----------------- ---------------------- -------------------------- FINAL --..FINAL INSPECTION BY:-----4R ---------------------------------- - 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.120.