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FOR OFFICE USE: 1 ------------------------ ----------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------------- - ------------------------ --------------------- 49/1- (Complete in Duplicate) T, Date Issued lQ-/-�_�S ----------------------- -- 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. I This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION /'Zo Owner's Name---,.-A°_ Pvj----------------------------------••---------------------------------------....------------- ---------------------- Address--- ---------------------------------------------------------------------------------------------------------•-•------------•-----------------------------------------•------------------ � Contractor's Name • T- -------------------------------------------------------------------------------•--•------------------- Phone_' ff.'s' 7 Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---1___ Number of bedrooms ---2 Number of baths ____L Lot size _..I pp_ Water Supply: Public system J!r Community system ❑ private ❑ Depth to Water Table 40 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 2T*�'New Construction: Yes ❑ No U�-- FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) , Septic ante: Distance from nearest well-----------------Distance from foundation-------------------.Material..-----------------------..----------.----------- No. --------.No. of compartments--------------------------Size-------------------------------Liquid depth--------------------------Capacity------=-- - ------ Disposal FJIpI: Distance from nearest well---- ---------Distance from foundation-_6� ...........Distance to nearest lot line__tr.....__. R11f4 Number of lines-----------------------------------Length of each line_. -f.'--------_---------Width of trench..,a�9_u_.-----:------_-._-- Type of filter material--.7tt-f.A-------Depth of filter material--__./__9... ......-Total length__ /,:r - b . , Coe l i Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------ Distance to nearest lot line-------..--.----- ❑ Number of pits----------------------Lining material--------.--------------Size-. Diameter.---------------------. Depth--------------------------------- ' Cesspool: Distance from nearest well----------------- from foundation_..................Lining material..--...-----._.---.-.______.-------- ❑ Size: Diameter---- - ------------------------------Depth----------------------------------------- ---------Liquid Capacity----------------------------gals . Privy: Distance from nearest well----------------------------------------------_Distance from nearest building-----. -----.-_-.------------.-____-.___.. ❑ Distance to nearest lotline-----------------.-------------------------------------------------------------------- Q Remodelingand/or repairing (describe):----------------------------------- ---------------------------------------------------------•----------------------------------------------------------- ------------------------------------ ---------------------------------- ------------------------------------------------------------------------------------- --------------------- --------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I and rules a d regu ations of the San Joaquin Local Health District. e (Signed)------------ `- `-- --------------------------------- - -------------------- ----------- --------------------(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 APPLICATION ACCEPTED BY --------------------------------------- DATE � REVIEWEDBY--------------------------------------------- ------------------------- ----------------------- ----------------------------- DATE-------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------ ----------------- DATE--.----------------------- -----------------I--------------- Alterations and/or recommendations:---------------------------------------- ---------------------- -----------------------•--------•-----._..-------------------- ------------------------------- -------------------------------------- --------------------------- -------------------------------- ---------------------------------------- --------------------------- --------------------_1------------ -------------------------------------------------------------- ------------ -------- --------------------- FINAL INSPECTION BY:-.--- +. --- -- ------ ... Date . r-~--------------- 4 AN JOAQUIN LOCAL HEALTH DISTRICT i 1401 E.Hazelton Ave 00 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.C Q.