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FOR OFFICE USE: ----- ------ -------*- Permit No. .. ---------------------- `} � APPLICATION FOR SANITATION PERMIT - f (Complete in Duplicate) -------------- Date Issued ----------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local alth District for a permit to constru t and install the work herein described. This a pli a 1 n is ma in co ce�with Count finance No. 49. / � l JOB ADD ESS AND LORY CATION------=�- ------------------ ------------- --•------- Owner's Name-_�_ n--------- --- ---------------•------- -----•------• - -------------------- -- ----------------_ ---------------------- Phone Address.-------q.��s',,�,--- -- ---- M_ --------------- -------------------------------------- ---- ---------------- ----- Contractor's Name----- Phone----------------------------------- - --------------------------------------------- - -- Installation will serve: Residence E3--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -./ �� --------- Number of bedrooms �__. Number of baths __1----- Lot size _-..-.-._____-.. Water Supply: Public system ❑ Community system ❑ Private PG—Depth to Water Table ."ft. f 3 feet: Sand Gravel ❑ San y Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Character of soil to a depth o ❑ Previous Application Made: (If yes,date_-____.--_------) No e New Construction: Yes gr1lo [:] FHA/VA: Yes �7No [I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted i�ublic sewer is available within 200 feet.) _ -- /� Material--- inc.� ----------------- Septi��k: Distance from nearest wel..vim..............Distance from foundation_.-..-...._--------- � ®�� l-7 No. of compartments-91- ------ -------------Size- Liquid depth `f Capacity./ �----- Disposal Field: Distance from nearest well y�._._Distance from foundation. �------- -------Distance to nearest lot line`SO _._Length of each line___ s'---_�._.-------Width of trench._..a-.--'.-.- ..�, 1 Number of lines-._._ _._..._ Type of filter material-�1 O.C/�-------.Depth of filter material--__Ar-_-_`-------Total length_-_-- -�"-------TIC. Seepage- Pit: Distance to nearest well_1O0_�'"____--Distance from foundation--/ -._.Distance to nearest lot line------ Seepage Number of pits._. ----- ------Lining material. 1_------- ----.Size: Diameter__3+3--_---.-------Depth_.v .-_ -1---------------- V/ Cesspool: Distance from nearest well----------------- from foundation------.-------------Lining material-------------------------------.._.-. i ❑ Size: Diameter--------------------------------------Depth-.------------------------------------------------Liquid Capacity---------------------------gals. i Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------.----------..-----._._-..-_---. ❑ 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 O ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 3 (Signed). (* � ---------------------------------------------------------------(Owner and/or Contractor) BY:--------- = --------------------------------------------- - lT'itler- - - - - . (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_---------------------------------------------------- ------------ DATE-------A7(90.__4--- ---------------- REVIEWEDBY--------------------------------------------- DATE ----------------------------------------------- -- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------------------------- DATE--------------_---------_--------------------------------- Alterations and/or recommendations----------------_---------------- ------------- --------------------------------------------------- ------------ ------------- ----------------------------•----------------- --------- ------------------------------- ------------------------------------------------------------------------------------------------------- -------------------- ------------------ ---------------------------------------------- --------- ---------------- ---------- --------- --------- --------------------------- -------------------------------------------------------------------------- FINAL INSPECTION BY•. - -t• ----------------------- 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.CO.