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FOR OFFICE USE: '----------------------------------------------; ----:--L APPLICATION F611 SANITATION PERMIT Permit No. ------------------------------------------------- (Complete in Duplicate) 4 ?ate issued ------------------------------------------------ This Permit Expires 1 Year From 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. f3 -0&oo•-Zer JOB A[ KS AND LOCATION_- _ _____d -_- f. _.__I' ✓--__ -. .%�- ""•1_ ° _` --_---.- I OwnersName vQS. _ Phone -� .91 . ,� Address - ----- --- ----- ----------------------------- --- ----- ---- - -- Contractor's Name-- ---5--�---�---------------- Phone----•--•-------------------•------- Installation will serve: Residence [ff Apartment House ❑ Commercial ❑ Trailer Court [❑ Motel ❑ Other ❑ Number of living units: __I Number of bedrooms __3__ Number of baths __ Lot size ._.Qe ----------------------------------------- Water Supply: Public system ❑ Community system ❑. Private [7T-Depth to Water Table .l-t<ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,dote_______________----) No New Construction: Yes Dr-No ❑ FHA/VA: Yes ❑ No [I - TYPE OF INSTALLATION AND SPECIFICATIONS: l (No septic tank or cesspool permitted if public sewer is availab[e within 200 feet.) r6�0 � Septic nk: Distance from nearest well- �_______Distance from foundation.OL---------.--.Material______-----__- __-_ ... ffr p -3- q p. �- - Capacity-kA-0 No, of com artments.. _P. ____._._.Size___ X_►)= .�____._Li Liquid de th._.____ _ Disposal Field: Distance from nearest well__ 4..`._Distance from found a#ipn__:60.- ___Distance to nearest lot line---r----.-- Aj Number of lines-----�--_____-___-.-_____.__Length of each iine__yy__�_'-----------....Width of trench....r�_.=T_`'...----------- Type of filter material-�� t C --------Depth of filter material.l._t'.`'_._.._`____Total length----APA_`---------_-__-_-_-.__; p `� Seepage Pit: Distance to nearest well......,.............._Distance from foundation---.---------------- Distance to nearest lot line-_----.-----_--- ❑ Number of pits----------------------Lining material------ --- -----------Size: Diameter-----------------------Depth--- ----------------------------- Cesspool: ---------- ------ j ` ' /�- Cesspool: Distance from nearest well___�# _1 from foundation_.___________!.__._.Lining material Size: Diameter_.__.---------- ------ - ---- ----Depth-------------------------------- -...--------Liquid Capacity-------------------- ------gals. Priv Distance from nearest well--------------------------------------._._......Distance from nearest building _. ❑ Distance to nearest lot line--------_-------- - - ----------- ----------------------------------------------------------- -------- ------- -------------- ------ ---- i Remodeling and/or repairing (describe):-------- -------------------I----------------------------------------------- -- ---- ---•---------------------- ---•-------- ---------------• --------------•------------------------------------------------------------------- ---------- ------------ -------------------------=--------------------------------=------------------------------------� . - ----------------------------------------------------------- ------------------------- ------------ ----------------------------------------------'-----'------------------------- " ------------{ ------:-------------------- ------------ --------------- ------------------------------------------------------------------------------------------------- ------------------------------------•---------------------- ----- I hereby certify that I have prepared this application and that the work will be doiie in accordance with San Joaquin County ordinances, State I ws, and"rules and regulations of the'San Joaquin-ocal-Local ------- ------------------------------------- Owner and/or Contractor (Signed)---- --- ---- - --- - g - (Title). ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY 2 APPLICATION ACCEPTED BY e.- ('--✓--��-�------------------------ DATE_. J ---------- --- _- .-r� REVIEWEDBY------------ -------------------------------- -------------------------------- ----------------------------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------- ---------------------------------------------- DATE--- ----------------------- Alterations and/or recommendations----------- -------- ------I--- ------ ---------------•-------------------------- -------------•--------------------------------••- ---------i-l------------ --------------------------------- ---------------------- ---------------------------------•------------------------------------- ----=- ---------------•----------------------- •----•-----------------------•-------•-----------------------------------•--- --------------------- -- ---- ----- ----------- ------------------------------------------------------ ---------------------------------------------------------- ------------------------------------------------------ ------------------------ --- -- --- -------------------------------- -----------------•------------- ---------------- -------- ------- ---- --------------------- ----------- FINAL INSPECTION BY:. � --------------------------------------- Date --- - -- ------ -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street �l Stockton,California Lodi,California Manteca,California Tracy,California F•.P.C O. 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