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III FOR OFFICE USE: 4 -------- -�-------------------- -- - _ ------ APPLICATION FOR SANITATION PERMIT Permit No. _ _.. ..___ ._._ _ ll� (Complefe in Duplicafe) II --- ---- This Permit Expires 1 Year From Date Issued Date Issued/ x 0p g Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work ererein described. This ap I—ication is made in compliance with County Ordinance No. 549. OB ADDRESS AND LOCATION--_- -- Owner's - --- €._ _sfe _ .�--_--- �_,,, ------------- �j �' ® G Name---- --------- - y✓ ----�->�.---------------------•=�----------------- - - ----------------- ------- Phone------------------------------------ Address_.--------------------- ----------------------------------- Address_---------------------- ---- .. i Contractor's Name------ --------------------------------------------------E� ------------------------------- Phone----------•----- - - ----• --- •---------------- ------ - ----------------•- Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: -- f--- Number of bedrooms ~~3 Number of baths -Au Lot size ------ ---------------------------- N Vrater ___________________________Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 27_0- ff. tharacter of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy lLoam o Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: l� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r.p Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------Material------------------------------------------------- 101 ifI ❑IIcompartments I� } No. of _._............. -_-Size_____.------ __ __Liquid depth--------------- ._ ---Capacity_------ ------------- Disposal -------- Dlis osal Field: Distance from nearest�well_-4.0-------- Dis ath of line foundation__________ _.Distance to nearest lotlinre______-'_.____. y ! Number of lines___-__-_ g f �P- --- -------.Width of french-----�' Type of filter material_��.d__Depth of filter materiaL.-._�_�-_----____._Total length__a.a_____________________-__.____ Seepage Pit: Distance fo nearest well--___________________Distance from foundation--------------------Distance to nearest lot line----------------- l ' ❑ Number of pits----- - --- -- -------Lining material---------!i----.--..-- Size: Diameter----------------------Depth---------.--------------- ------ i ll �li esspool: Distance from nearest well________________Distance from foundation_- ------------ -- Lining material-------------------.-_--.___--_______ j ❑ Size: Diameter--------------------------- -------- -Depth--------- i1-----------------------------------------Liquid Capacity----------------------------gals. I� Privy: Distance from nearest well-------------------------------------- ----------Distance from nearest building---------------------------------- -----_- ❑ I Distance to nearest lot line -------------------'----� ---- ---- --- --------- - -------------------------- ----------------------- - - ' modeling and/or repairirq (describe -- - ----- ----------rF - , ^------- . - -- - - - - - --------------- --- ` ----- -- -l�- ---------- ------- ---------- = ----------------------------------------------- .:4 II Ili I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County J 1rdinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)______, 4 ____ ` ------------------------.(Owner and/or Contractor) By� --------- --- I! (Title) (.Plot plan, showing size of lot, location of system in relation to wells, ibuildings. etc., can be placed on reverse side). r 11 ill! FOR DEPARTMENT'�USE ONLY Ar PPLICATION ACCEPTED BY_ � Lt- --------------------- ------------------------------- DATE--/)-I--`-�-`�- REVIEWEDBY-------------------------- ---- ----- ----------- ------------------------- ------------ -:-------------------------------- DATE------ ----------------------------------------------------- B.rUILDING PERMIT ISSUED------------------------------------------------- - II-------------------------------------------- DATE-----,-- --------------- I�lterations and/or recommendations:-------------------------------------------- -----------------------------------•-- ---------------------------------------------------------------------- ---------- -------------------------------------------------------------- -- - -------- - - -------- ------------I-------------------------------------------------- i�. II '1�-------------- ------ --------------------------------------------------- -- - - -- --- -- ------------1--- ----------- -- - -- - - - -- -- --- ---------------------------------------------------------------------------- -------- ------------- --------------------------------------- ------ - --- ------------------------------ --------------- --------------------------------- ------------------------------------------------------------- FINAL ------- ------------------------FINAL _INSPECTION BY:.- - -- �,.. ------------------- Date_/ .1_`_ .-_- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca, California Tracy,California I F.P.Cfl.