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--------------- --------- ------------- --------- ----------_ __-..___..._._. APPLICATION FOR SANITATION PERMIT Permit No. .. .� l�' - ------------ ' (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date 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 made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION---------K_i 'U �'--------... Owner's Name---------- r - - --- ------------------------- ---------------------------- - - one --------•-------------------- ' Address----- -- --�----�----��-r----�.7-� �---------�`--------- Contractor's Name %�-• ---------- ----- •-------------------- Phone. Installation will serve: Residence O^Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --./.._ Number of bedrooms ._2.._ Number of baths �... Lot size ----, ._ -" ------------- Water Supply: Public system ❑ Community system El Private ["Depth to Water Table /9-' ft. 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 E[ New>Consfructlon: Yes ❑ No gL FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: - - - -, (No septic tank or cesspool permitted if public sewer"is,available within 200 feet.) �' I 11 ' Septic T nk: Distance from nearest well................Distan�9ce from foundation----------------.-_.Material-...__----- --_.__...------_ No. of compartments------ ------------------Size---------------------------------Liquid depth-------------•- CapacifiY ------------------- isposal ield: Distance from nearest ®� _-_--.-f---'--_-.- .. m.foundation--_ _. -. fl Number of lines---------- __ erof ___.-- nearestot line--- I' ---Length of each'line--------/..;sAl2_,-------Width of trench------ ,-- --,------------ Type of filter material....... u-!:�l<----Depth of filter material-----L-�'--`-'----Total length------- -`--a_r Seepage`Pit' Distabnece oto nearest well=-- -Linin Distance from foundation---_------- . ._. . - . . . Distance to nearest lot line............. ... P g material - Size:`Diameter-----------------------Depth---- ------- - Cesspool": " Distance from nearest well-----------------Distance from foundation__-------------Lining material.----__-..__._-....__----.__---- _._.. .. . Size: Diameter---•--------------------------------.-Depth-------------------------------- ------- Liquid Capacity gals. Privy: Distance from nearest well Distance from nearest buildin ❑ Distance to nearest lot line.-------------_----------------- 1, ----•---------- Remodeling and/or repairing (describe):...__..-------------_------------------------------------------------ ------------- ------------------------------------1__ -------------------•---- - ------------------------------------------------------------=-------•----------------------------- ---------------------•--------------------------- --- ------------------------------------------------------ - - ------------------------- --------------------------- -`1------------------ ---------------------------------- 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 rules and regulations of the 'San Joaquin Local Health .District. .(Sign ed)------------- i--- Z' J ----------------- �..�- •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 W APPLICATION ACCEPTED BY-------I---I R- ------- ----------------------- ------------------------- .. DATE-----, REVIEWED BY DATE u - UILDING PERMIT ISSUED ------------- ------------ -------------------------- ------- ------- ---•---- DATE.------•---- -------------------------------------------- Alterations and/or recommendations:....................... ..." - ------------------------------------------ ........................................ 4 FINAL WSPEC --- - ---- - Date----------- SAN JOAQUIN LOCAL HEALTH DISTRICT - 1801 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.w.co.