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FOR OFFICE USE: 3 _ ` �/��----------------- ---- -_ APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date Issued':-7.-:__ 1�' ' _ 7 1 __________ __ __ _�- This Permit Expires 1 Year From Date Is;ued P , 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 AQQRESS AD LOCATION---aZD__S------ } . r f, Owner's Name-_-_1 _ ____-- ---- r!C' 2- .___ ---------------------- Phone--------------------_------------- Address -• Address____=sCT _____. ----------------- .................---- --•-----••-----•---------------------------------------------------- Contractor's Name------ .. _ ( ...............F Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1__. Number of bedrooms 3-._ Number of"baths _�____ Lot size ____________________________________________________________ Water Supply: Public system Community system El—Private ❑ Depth to Water Table W-'o- ft. Character of soil to a depth of 3 feet: Sand L] Gravel ElSandy Loam ElClay Loam El Clay ❑ k.Adobe Eq--Rardpan C] Previous Application Made: (If yes,date____________________) No New Construction: Yes ❑ No P —FHA/VA: Yes ❑ No � TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep41nk: --- Distance from nearest well-----------------Distance from foundation--------------------Material--------------------------------------__...___.._. No. of compartments------- ------ Size--------------------------------Liquid depth_-- ---------------Capacity----------------- Disposal Fie Distance from nearest well-- `-._._____Distance from founclationlo_..............Distance to nearest lot line.-`�_/_____ ❑ Number of lines---.--'--- -- ------------------Length'of each line__..392----------------Width of trench.._s�--._'-__.._.----------- Type of filter material-_ 0CA�__._-___Depth of filter material__.l9._y____..___Total length------- Seepage Pit: Distance to nearest well----------------------Distance Aom foundation-_!�fl_."___.----Distance to nearest lot line�/______ l� � � l Number of pits___ -------------___Lin-sng material___1�D�� _-5ize: Diameter------��-__.___-_Depth-----,_-___-�_�___------------ Cesspool: Distance from nearest well-----------------Distance from foundation--------- _----------Lining material_____________________________________. O ❑ Size: Diameter----------------- --- ----- -------- Depth--------------------------------------- --------Liquid Capacity-- -----------------------gals. Privy: Distance from;-nearest well-----------------------------------_-------------Distance from nearest builcling----------------------------------------- r7l Distance to nearest lot line------------------------------------------------•---------------------- --------------------------------------------- Remodeling and/or repairing (describe) - --i--- - ------- -- ----------------f----`------------- ------------------------- --------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------•-------•------------------------------------------------------------------------------------------------------------------------ --------------- ------------------------------------------- ----------------------- ------------------------------------- ----------------------------------------------------------------------------------------------------------------- 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 les and regulatio�e San Joa uin Local Health District. (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----------------------------- -/- -------Ine--- ---------------------------------------- DATE----------%/x/��._ -- - -- ---------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------ DATE--- -------------------------------------------------------- BUILDING PERMIT ISSUED------------- ----- - -------------- --- DA-TE------------------------------------ Alterations and/or recommendations:--- --------- ---------------------------------------------------------- ------------------- ---------------- -•------------- ----------- ---------------------------------------------------------------------------------------------------------------------•-------------------- ---------------------------- -------------------------- ---- - -- - - - - -------------- ----------•------------------------------------------------------------------------------------- ---------------------- ------ --------------------- I FINAL INSPECTION BY:------ ---------__ Date--- 6_ - ---------------------- ; 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.R CC.