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FOR OFFICE USE; ------------------I-- ----------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. y{Complete in Duplicate) k Date Issued 41_�4• _�� - ----------------------- A _ . ---.._.. 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 ht i it +J cC+ Zl� I This application is made in compliance with County Ordinance No. 549. 82[ - 2 �� JOB ADDRESS AND CATI J wwt 1 Owner's Name��j-------- ------------ - -------- - - ` - Phone Address '�t !� --------------------------------------------- -------------------- Contractor s Name--- t-- --••------ � �- Phone. Installation will serve: Residence Apartmen# House ❑ Commercial [I #Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms ---- Number of baths -7----- Lot size ---- --------- ---------------------- _______.._ Water Supply: Public system ❑ Community system ❑ Private [!f Depth to Water Table --- ---- 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 ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ y TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 2o6 feet.) V r F i —.� f Septic nk:. Distance-from nearest well------ from f_aundation_.._f4 ___ _-_.Material- --_- __ ':-._.___-- / I "/--.�- r -- ,r No. of compartments__-_-. f.... `...Size_ _4�__/�_-�-�`-''___Liquid depth-------________________Capacity__ c--a _- f Dispos Field: Distance from nearest wellg�O___t---Distance from foundation-----Ia� --Distance to nearest lot lines'�___--7r- Number'of lines- ___-?�-''f._..____y�___--___Length of each line_______f_.Qo-__-.______.Width of trench_._._._ -----__.__._ _.__De Depth of filter material____._l_q.____.__..Total length- +CG52------------------------- -. of,filter material____.-�_�1_L.. p 7 Seepage Pit: Distance to nearest well----------------------Distance from foundation------------.-------Distance to nearest lot line----------- ❑ Number of pits----------------------Lining material--------------,:--.....Size: Diameter-----------------------Depth----------------------------_---- G Cesspool: Distance from nearest well------ _.__.._-Distance from foundation...... ............Lining material------------------------------------- - . �. ❑ Size: Diameter-- -•------------- ------- - ---------Depth----------------------------------------------------Liquid Capacity—-------------------------gals. A Privy: Distance from nearest well-------------------------------------------------Distance from nearest bui4ding----------__-_________________-.-____. S ❑ Distance to nearest lot line------- ---------------•-------------- ----------------------------------•-------------------------------------- - ------------------------- € 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 la ltd rules and regul ons f the San Joaquin Local Health District. I(Sig +--------- --- --------- - -- - - -------------------------------------------------------------------- _ and or Contra-ctor ned)------------- ----------(Title]------------------------------ .._._. .......-------- --- - ----- ---------------- - ------------- ----------- -BY: I (Plot plan, showing size of lot, location of system i relation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED -------- -------------------------------------------- DATE--- 7--�'-��---�--�------ ----------------- :: REVIEWED BY-------------------------------- --------------- =--------------------. DATE----------------------------- -------•---------------------- BUILDINGPERMIT ISSUED------------------------s--------------------------------------•--- -=---- DATE--------------------------------------- ---------- ----•- Alterationsand/or recommendations:----------------------------- - ------- ......... ---------------------------------------------•-------------••----•------------------------------------------- ----------------------------------- ------------------------------------- --- -------------- ------------------------------------------------------------------------------------------------------------------- ------- --- - FINAL INSPECTION BY:. ------ - --- Date-.27-11----'" `' _.__._ - _ - ----- SAN JOAQUIN LOCAL HEALTH DISTRICT I 1601 E.Ha;elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.