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FOR OFFICE USE: -- -- ----- '------------ A __ __�_�____----.-__.______--_ APPLICATION -FOR SANITATION PERMIT Permit No: ..a�L:%1.� - --------------- (Complete in Duplicate) Date Issued --------------------------- -------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 6(TC-f�' JOB ADDRESS AND OCATI Ntlo ----�`---------C- _ . Owner's Name. • - @ - - -• -•----------------------------------- -------------------------•------------------ Phone.................................... ,— r Address �� 'a Contractor's Name - -• ------- - --- -------- ----------•---•-----------------•---------- -- Phone- =.'�#... i•� Installation will serve: Residence g?e partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -Z...- Number of bedrooms --_umber of baths ---I--- Lot size -----_1 0-1--- Water Supply: Public system ❑ Community syst F] Private epth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay F] Adobe❑ Hardpan Previous Application Made: (If yes,date--------- ------._-) No New Construction: Yes E] No HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ipkDistance from nearest well---- -----Distance from foundation--Za---------Materi ___ __ _ ------- No. of compartments-----_-_�--------.--Size------ •--------------------Liquid de th-----4 --------Capacity---�d� Disposal „ Field: Distance from nearest well___ U--.-Distance from foundation----f ---------Distance to nearest lot�line----- _________ Number of lines-._.�---- ----------------- Length of each line-----�a----.-----_---_-.Width of trench.__. f__..__--_. ---.-_-__--_ Type of filter materiah��._Depth of filter material---9--------------Total length----I-e-10------.._.--------------- 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------------------- material_-_.._._.---__------_----_---_---_-. ❑ Size: Diameter.__. -------------- ----------------Depth------ --------------------------------- ----------Liquid Capacity.---------------------------ga� Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------._.-.___._. ❑ Distance to nearest lot line- ----- ----------- ------------- --------- ---------------------------------------------------------------------- ------------------------ Remo eljng and/or repairing (describe)- - ------- - -_'8- =``� ---- .. z" -----------•---------------------- --------------------------------•----------------------------------•------------------------•----------------------------------------------------------------- ---------- -------•------•----------------- ---------•-----•---------------•----•-----------------------------.--------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------•--------------------------------- I hereby certify that I have prepared this ap lication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulation f the San Joaquin Local Health District. -- (Signed) 64Ci` y� (owner and/or Contractor) BY�--rowing. -- -- -----------------------------------------------------------------------(Title) - - - --- -- --------- (Plot plan, se o W. location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- F DATE.-----/ 40-4-------- REVIEWED BY----------------------------------- DATE ------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE----------------------- - ------------------------ Alterationsand/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------- ---------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------- --------------------------- ------------------------------------------------------------ ----- --- ------------------_------- FINAL INSPECTION -- ---- --------- -------- Date (-( l �d� 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.F.0 O. .z,