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v,♦ VI I I%,L UJC: q r-�- J_ Lr> -I--- ------------- -------41-11-1--c- ----- - �- ------- I-1--+=- -- ---5----------i_- r APPLICATION FOR SANITATION- PERMIT Permit No. ----------- ------ (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 compliance with County Ordinance No, 549. JOB ADDRESS AND LOCATION_._--_-- _ _ /_ r ---- -• ----------------------------------------------- ------------------------------------- Owner's Name ,L�------- ---------------- ----------------- ------------------------------------------. Phone.. Address-------- -__ _,/ ,� 'II �------ Contractor's Name-------------- __ -�_ --------� Installation will serve: Residence Po"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel.- Other Number of living units: _-1-- Number of bedrooms _>,�--- Number of baths A._ Lot size � � ❑ Water Supply: Public system 9TIO'community system ❑ Private ❑ Depth to Water Table - ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date-------- -----------) No ET"'New Construction: Yes ❑ No ®/ FHA/VA: Yes ❑ No F�-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) k%., Distance from nearest well-----------------Distance from foundation-_---- -------------Material ----- --------------------------------------- IAW5_140 0 No. of compartments------------------------Size-------------------------------Liquid depth--------------------------C Disposal Field: Distance from nearest well------- ---------Distance from foundation--------------------Distance to nearest lot line-,-,_-__---_--_- 457 �/flt�01� Number of lines--------------------------------Length of each line------------------------------Width of trench----------------------------------- Type of filter material----.--------------------Depth of filter material________________ ------Tota I length-------------------------------------- eepage Pit: Distance to nearest well----^ Distance from f undation. �y !! ---------Dist rice to nearest lot line__-47 (�_ Number of pits-----/_.______-__Lining material- - �,��' '�� -Size: Diameter___------___-_---__-Depth-? __,,_W,4 Cesspool: Distance from nearest well__ _Distance from foundation--------------------Lining material________._________________ _ ❑ Size: Diameter___ Depth______ Liquid Capacity- ____-__ -----------gals. ----------------------------------- Privy: Distance from nearest well. ____ -___________________ __Distance from nearest buildin g----------------------------------- -- 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, and rules and regulations of the San Joaquin Local Health District. (Signed)----------------------------------------- - --- Contract ) - --------------------------------------- By: f - - -(Title)-- y or (Plot plan, showing size of lot, location of system in relat' to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_.____._ __ -_�'__-_- l�iys� -- --- DATE----- REVIEWED BY - - ------------------ ----- DATE-- BUILDING PERMIT ISSUED-------------------------------- - - ---------- --------------------------------- --- --------------------------------------- ------ DATE---------------------------------------------------------- Alterations and/of recomnpendations:-- - -/ -/ -� r '----------- ---------------------------------------------------------- --- - -- ---------------------- - - --------------------------------------- FINAL INSPECTION 3 - rSAN Date- _____AQUIN 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.