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OR OFFICE USE; APPLICATION FOR SANITATION PERMIT Permit No. /l� (( (Complete in Duplicate) --:. De#e..iss�rsd ---- ------ _______________ 3 a�_. }T_trirs Permit Expires 1 Year From D'at_e 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. / k JOB ADDRESS AND LOCATION--------- F (-1f Q�,E� ----------------•--------------�--r---------------/---------._.... Owner's Name----- . �- �� i�� fE�-----'L.f�_�/�/SO .:----------------- -- ----- --'--=_---------------- Phone'T� 13 Address.... -----------------••-------......... ---- S /i "--...o'er r Contractor's Name----------- / ./S ------. ------------------------------- -------------------------------- Phone- 1�6-- ' -4.7 I Installation will serve: Residence Ue"A'rartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---f--- Number of bedrooms __J'_ Number of baths .../__ Lot size ____ +��?__ __J.__�__________________________________ Water Supply: Public system [9"Community system ❑ Private ❑ Depth to Water Table 1.5,ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loamfg--Clay ❑ Adobe ❑ Hardpan ❑' Previous Application Made: {If yes,date____________________) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ i TYPE OF INSTALLATION AND SPECIFICATIONS: { I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ; i fSeptic Tank: Distance from nearest well-----------------Distance from foundation---------------:__.Material________________________._______-_-.--_____. l ❑ No. of compartments--------------------------Size--------------------------------Liquid depth------------------------- Capacity----------------------- f I Disposal Field: Distance from nearest well----------------- from foundation----------------.__Distance to nearest lot line________-___-__ Number of lines_---____ Length of each line__-__f,4-------------- of trench-__ - _-_-_______ ❑ f - g l/ Type of filter material__ 6�e_lV�t '� . __Total length___._r i �' er material-__.______; `- ' Seepa Pit: Distance to nearest well-------------------!_-Distance fr foundation___��---_____.Qistance to nearest lot line_._-__--_ Number of pits---.__./-__.-._____-Lining material- 5',��t'__-Size: Diameter y__F--`-__.____.Depth__o�. -s Cesspool: Distance from nearest well_--------------Distance from foundation--------------------Lining material_------____--___----______________- I ❑ Size: Diameter-- --------------- ------ P - --Liquid Capacity-.--------------------------gals. CPrivy-, Distance from nearest well-------------------------------------------------Distance from nearest building-J._-__._____._-_-______________-.__._. 4. ❑ Distance to nearest lot line ----- -- ---------------------------------------------------------------- ------------ ---------------- ------------------------------ r ' Remodeling and/or repairing (describe):--------=��/ --ei6--- ---------------------------------- S � _____________________________________________________________________________________________________________________________________________________________________________________________________________________ ______ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________ ___ _ _ _______________________________________________________________________________________________________________________________________________________________________________________________--_-.-.- j I hereby certify that I have prepared thin application and .that the work.will,be done in accordance with San Joaquin County 4� ! ordinances, State laws, jlru"d regulations of the San Joaquin Local Health District.I (Signed)------------------------- rid/or Contractor( 4 ' ne ----- Title---- - -...- - - (Plot plan, showing size of lot, locatio of system in relation to wells, buildings, etc., can be placed on reverse side). Y1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- ---------- ---- -- ---- ------------------ ------ DATE_T__!�_ ------------ REVIEWED BY - ------------- - ------ --------------------------------- DATE------ -----------:----------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE--------------------------------------------------------- -- Alterations and/or report7mendationss------------------------------------------------------ ------ •------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY:.._.J..:---_�ZDate G� �� --•-------- __ -------------------------------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street f Stockton,California Lodi,California Manteca,California Tracy,California r-.a.c o.