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FOR OFFICE USE: { LQ-sS_ -------------------- �l-- ---- APPLICATION FOR SANITATION PERMIT Permit No. : 1 I.. �- - --- -------------- (Complete in Duplicate) Date 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.-7 r b OB ADDRESS AND OCA -1 N--. —� t_.�------------------------------------------------...... ----------------------------- Owner's Name---------------------••------------ -=--------- _ --------- --------------------------------------- Phone---�----- --- ----- L�••r�� i Contractor's Name ------ . ......... -•---- - Phone----••-•------------------------- I Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /---- Number of bedrooms_ r----- Lot size --- / , _-:_ Number of baths (- �p--------- -----�-f-----�--•-------------- Wafer Supply: Public system [P,'Community system ❑ Private ❑ Depth to Water Table ft. i Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Clay Loam Clay Adobe Hardpan P ❑ ❑ Y ❑ Y ❑ Y ❑ ❑ ❑ Previous Application Made: (If yes,dote....................) No New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ EI TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic-tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k:- Distance from nearest wel6n.'------�isfancefrom f9undat n----__�_ ._._.Material__��------------------------------- 1 No. of compartments--------�___-_..Size__ _ j( Liquid depth----------4..�______Capacity_-/__Z__ Disposal Fiel Distance from nearest well.&fit.`_lJ stance from foundation----------.---------Distance to nearest lot line-------------- _ 7 Number of lines-----------------------------------Length of each line-------.---------------------Width of trench----------------- Type of filter material-------------------------Depth of filter material__________.__._______.Total Seepage Pit: Distance to nearest well----------------------Distance from -foundation---------------------Distance to nearest lot line__.__,__________ ❑ Number of pits----------------------Lining material_--------- ------------Size: Diameter---------.------_------Dept h---------.-.---------.----------• �, Cesspool: Distance from nearest well-----------------Distance from foundation-_.__M------------- Lining material_-.--.__________._..__.______________- ❑ Size: Diameter-------------------------------------Depth-------------------------------------- .............Liquid Capacity.-. -------------- ---- ----gals. ;Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-------------------------------.----__--- ❑ Distance to nearest lot line--------------- -------------------------------------------- --------------------------------------- ------------------------------ I`IRlrt- es�cri:b•e):----- �emodeling and/or repairing �'1 , -------------------- --------------------- �--c-�-- - ---------------- '� ---------------------------:-------------------------------------------------------------------------------------------- ----------- - ------- =-------- - ------------------------------ II 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)---�L -----Y7. Owner and/or Contractor By-------------------------------------------------------------------- ---------------- ----------------- ----------------- - -----(Title)------------------- ------------------------------------------- (Plot ------- -------- -------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). E� FOR DEPARTMENT USE ONLY YPPPLICATION ACCEPTED B -- -- ---� ------------------------------- DATE------ -�~.- Il / ;REVIEWED BY------------------------------------- -- 6 _ ---------------------- DATE---�---- � BUILDING PERMIT ISSUED -------------------------------------------- DATE------------------ -------------_---C�---------- Zi ` z Qr len IAIM lterations and -c9- da�toCn�s ._a___ -� ?-�-. ----- ...... --------- C—r - --------------- ------------------ ------------ `--------------- ----- --- . --------------------- FINAL INSPECTION BY:- - ------------- ke -- 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