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FOR OFFICE USE: ------------------------------------- ------------------- APPLICATION FOR SANITATION PERMIT Permit No. ---------------- ------ (Complete in Duplicate) ------------------ This Permit Expires 1 Year From Date Issued Data 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-rriade in compliance wit County Ordinance No. 549. JOB ADDRESS AND LOCATIO ---- --.,�/J�?� Owner's Name �/�l f ------- -------•-----= ----------- -M- _12 one Addres s .'° . L = 6 - - ------ ------ Contractor's Name---------- ------------------------- Phone------------.. _. ..... Installation will serve: Residence ❑ Apartment House I] Commercial E] Trailer Court E] Motel ❑ O Number of living units: I--- Number of bedrooms --/f---- Number of baths _X__ Lot size �/ ~ '-* Water Supply: Public system ElCommunity system .❑ Private epth to Water Table aft t. } Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date.......... ---------) No [ New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No g— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic, TanL: Distance from nearest well-----------------Distance from foundation--------------------Material-.___-_----_.-.._..---_---_--______._..__------ f No. of compartments--------------------------Size---------------------------- Liquid depth-------------------------.Capacity-----------•------- Vv G Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line-____----------- 4�,9y1+ Number of lines-----------------------------------Length of each I;ne------------------------------Width of french----------------------.------------ }Type of filter material----.-.--___--._________Depth of filter material__-_----_-__--- ----Total length__________________ _____ ___-_--_----__-. • r Seepage Pit: ...Distance to nearest well__ __----Distance f m fo n ation__ =' Dist r e to-nearest I t ipe N\umb of�plts-,; _!--t----------Lining material- rj� -.Size: �Diameter._a ..:_. -__Depth_ i Cesspool: Distance from nearest w� elm I-�;._--- .--Distance from foundation Lining material- --------------------------.-.__--_ . .,..❑ .: . �: Size: Diameter, Depth--. -- - � =Ltquici-Capaciity— _ -gals. Privy: Distance from nearest well -------------------------- ---_ . Distance from nearest building------------------------------------------ Distance _--.-----._- --___-_---_-_----_..___.._. �� ❑ Distance to nearest1ine----------------------------- --- ------ ---------------------------------------------------------------------------------------------------- A 70 Remodeling and/or repairing {describe):--- ------t ------ -- -----------------------• ---------------------- ---. ------------------•---------------------------------- ---------------------------------- ----------- . __ ==--.------------------------------• ----- -- 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 r es and regulation of th'e-Sart-Joa-quin-I_-oc-al-Health-Districf. (signed) - = = � •e�.Contractor) --�.T tl--:` By:--•--------------------------------------------------------------- i--------- ........_._. ---- (Plot plan, showing size of lot, location of system in re 'on to wefls _liu Idings, etc., can be placed on,rev�erse side). I FOR_DEPARTMENT USE ONLY ..-. ,� _ __________________ _------------------------------------------. .___..____ .- 4 .�a��g_w y APPLICATION ACCEPTED SY - DATE--------•-------- ------------- REVIEWED BY -- ----------- -- DATE---------------- �� gt' BUILDING PERMIT ISSUED---------------------------------- ------ _��--------------------- DATE. Alterations and/or recommendatrions-------------- - ---------------------------- -------- -------------------------------------------------------•---------------------------------------------- -----•-------- --' -------- ------------------------ -------:---- -------=--------------------------------------------•------------ -----:_------------------------------- T F,I.NAL INSPECTION BY-----------------------� ` F'.�"�'1 Date---- ---------- T------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT, 1601 E.Hazelton Are. 300 West Oak Street >l; 124 Sycamore Street y .- 205 West 9th Street Lodi,California" Stockton,California ;�"�:Manteca,Califarnia++�` Tracy,California F.P.C❑. + k I