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FOR OFFICE USE: ---------------- -------------------------- ------------- APPLICATION FOR SANITATION-PERMITPermit No. (Complete in Duplicate) r Date Issued .._._-_-/_�` -------------------47A-A--�------------ ------ This Permit Expires 1 Year From Date Issued -'--�-� a 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 ALD LOCATION Owner's Name-- +/ ----------- Phone------------------ - -------------------------------------- ------�- ------- ------------------ Address-----. .. ..* :. ---- -----------------------------------------------------------------------------------------•----- ----------•-•-------------------------------- Contractor's Name ...S27,_i - ------------------------------------------•---------------------------------. Phone----------------------------------- Installation will serve: Residence F" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----(--_ Number of bedrooms _-,2-- Number of baths __1---- Lot,size ----L5-P - ------------------------ Wafer --__ _Water Supply: Publicisystem Q Community system ❑ 'Private ❑ Depth to'Water Table .loft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [5—Hardpan ❑ Previous Application Made: {If yes,date--------------- ) No 9D-`� New Construction: Yes Pi"No ❑ FHA/VA: Yes E] No�--� TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well----- ----Distance from foundatiow----------------Material--- �- No. of corn partments----.�Z-----------------Size__;7x_''�9--------------Liquid depth.........�----------------Capacity----- r pr'- -sem Disposal Field: Distance from nearest well----�--------.-_Distance from foundation--- ------------Distance to nearest lot line----- ------ Number of lines----------1-----------------------Length of each line-----7,0�------------------Width of french----� _ t Type of filter material--._. oC�---------Depth of filter material--_._18__Y- -----Total length__-- c- ------------------------------- CN Seepage Pit: Distance to nearest well----- --------------Distance from foundti aon---�p-----------Distance to nearest lot line---- --_-----__ U—' Number of Pits-_.----4------------Lining maferial__---;E�t«t----Size: Diameter-----!7 a.._______Depth-------Kms---- ------------- \`� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- ❑ Size.: Diameter----------------------r---------------Depth------------------ ---------- ---------------------Liquid Capacity- -------gals. Privy: Distance from nearest well------------------------------------ -------- --Distance from nearest building------------------------------------- ❑ Distance to nearest lot hne-------------------------------- - Remodeling .and/or repairing (describe)------------------------------------------------------,---------------------- --- -----I------------------------------------------------------------------------------------- ----------- -------------------------------------------------------- I hereby certify th t 1 have prepared'tliis applicafionand�"thaf fb_e worVwill be done in accordance with San Joaquin County ordinances, State law n �ules, a r ulations of the San Joaquin Local Health District. (Signed)---------------------- t --------------- ------- -----------------------------------------------------(Owner and/or Contractor) By:---------------------- -------------------------------------------------------- ------------------------------=---------------------(Title)-------------------------------- ------ ----------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 4 01 APPLICATION ACCEPTED BY-------------- -- ----------------------_----- --___`-___-_.- -------------------- DATE----------- - - -- ---------- ------------------------------- REVIEWED BY--------------------------------------------- ---- --------------------------------------------------------- DATE__ BUILDING PERMIT ISSUED_________________________ - ---- ATE-------------------- ------- Alterations and/or recommendations:..___ _ � - _- - ----------------- ---- ---- ------------- -------------------- --- ------- . . .._ .� -------------- --.- FINAL INSPECTION BY:...... ----------------- ---- -- -- o - ----- -- Date--------------- - �=-j��- ----- ------------ 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 F.P.CO.