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FOR OFFICE USE: , 4 =------------------ ' = ' -------- ------------------- M' / ___---_____________ /h _��__ APPLICATION FOR SANITATION PERMIT Permit No. ---------- (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 nd install the work herein described. This application is made in compliance with County Ordinance o. 549. .�� .. JOB ADDRESS AND L CATIONfe ��r ,__ -----------•-- Owner's Name------- s ---••- -----` .- - ------- J -C=---- 0' Phone - Address - ..V. T --------- / ----- _________'-,---- _- ' - ----------------------------•-------- Phone------------------------•--------- .Contractor's Name. ... .. Installation will serve: Residence ED,-<p—artment House ❑ Commercial ❑ Trailer Court ❑ M teI C] Other El Number of living units: __/___ Number of bedrooms Number of thst/____ Lot size _ _ � _ ---------------------__..__ Water Supply: Public system ❑ Community system [] Private Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam ❑ Clay Loam [] Clay ❑ Adobear pan ❑ Previous Application Made: (If yes,date____________________l NoNew Construction: Yes to ❑ FHA/VA, Yes to E] r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 411 Septic Ta . Distance from nearest well__ ....-f__Dista/ngi6 frr fou d?�tion_../.4____i_____-Mate Tal--- . ''��. ------ _------- No. of compartments----�---________Siz4_ _V11�"__X__�u.___Liquid depth____ ./. -_"Capacity_] Disposal F Distance from nearest well____ .Distance from foundat'on__/U__ ____.Distance to nearest lot 1-ne___,�/ - --------- Number of lines------gy Length of each line___ _. _ .Width of trench_s . __si'( -------------- ------ - Type of filter material---.�_Yy�_ "Depth of filter material___�_}� ��_____Total €ength----- 1 �_________________ Seepag it: Distance to nearest well----/ _____:Distance m oundation____ _Q__ ____.Distance to nearest lot line_ yi - --------- Number of pits----- )L,-)- Lining material----I�� __�ize: Diameter_3,,1._,%---_---- Depth__s�_:�_--__ a T Cesspool: D stance from nearest.weli _-,___^____.,Distance from foundation__ _.Lining materia-----------------__________ __________ ❑ Size':Diameter- --;"-'--- Depth --:Liquid CapacitY ----------- - gals " Privy:. ( Distance from nearest well____!-------------------------------------------Distance from nearest building........_-____________-_________________.4 ❑ Distance' tonearest lot line.-'-_--------------------------------------------- -'- -------- ------------ ------- ------------------------------- -- --'---------•------'------------- - �---------'------ -------------- - ----'.-�" Remodeling and/or repairi�q (describe):__------ "- _-_ _ 1 -- -- -------------------------------------------•-------------------------------' I1 # r -------------------------- -- - - -- --------- --- ------- ----------------------------------------------------------- -----------------------------------_-- ---------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State and rules an gulations of the San Joaquin Local Health District. (Signed) -- ----i______-- t�-�- ----- (Owner and/or Contractor) By: Aa—_ f - ---------- -- plan,'showi g ze of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------1(- ---------------------- -- ----- ------ ---------------------------------------- DATE--- - REVIEWEDBY---------------------------------------------'--------------------- --------------- ---------------------------------••------- DATE BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------- ----------- - DATE Alterations/n ,/or recomme ati ns _ ____--------_______------------- is~ r�- n � . p '-- -- 'c 1-- --------------------- s= --- = ::f •--------------- ::. --------------- --------- FINAL INSPECTION BY:-.---- ��----------------------'- --------'------------ Date__.-' i `f --------------'-'--'-' 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 4'