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FOR OFFICE USE: --------- -------------------------- -------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..... --------------- /jam (Complete in Duplicate) f' �------------------------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 and install the work herein described. This application is made in compliance with County Ordinance No. 549. 4 JOB ADDRESS AN OCA71 /-{ .,-�0-.--_. - Owner's Name ------------ Phone Address-- ----- --------------------- :f j Contractor's Name7 Phone .............. I? Installation will serve: Residence Apartment Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other, 1 Number of living units: --u- Number of bedrooms .--Number of baths --!V- 'Lot size--jo&__ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobek Hardpan ❑ Previous Application Made: (If yes, date____________________) No [� New Construction: Ye No ❑ FHA/VA: Yes ❑ Nox TYPE OF INSTALLATION AND SPECIFICATIONS: /\ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__So____DistKXA from f dation_ __ a Mat I No. of compartments -------7 '_•---------Sixe�X L'quid depth-------- - ----Capacity. e / J Disposal Field: Distance from Weare wellQ -___Distance frdo>n(Jafion___._-'a_____.Distance to nearest lot life Number of lines--___ __---------- IM_______ Length of each lme_,��---------- Width of trench.____,�.� _------------ Type of filter mat rial_.._5'4. �� Depth of filter material ----- length ------- ------ -------------- Seepage Pit: Distance to nearest well ---------------------- Distance from foundation ----------- _........ Distance to nearest lot line ------- -._____.-- ❑ Number of pits---------------------- Lining 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 building ----------------------------------- - Distance to nearest lot line Remodeling and/or repairing (describe): --- --- ,a- - --------------------------------------------------------••--------------------------------------------------------------------------------------------------------- ----------------------------------------- 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. f ___.__________(Owner and/or Contractor) (Signed)--)( ---- ------------- gY� -- •--•---- -------------------------------------------------------------------------------------------------------{Title(---------------- :---------- (Piot 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 ------------------------------ ---------------------------------------------------------------- DATE_ ------------------ --- REVIEWED BYyE3�� �J ---- ------------------- BUILDING PERMIT ISSUEDDATE -------------------------•---------------------- -- --- - Alterations and/or recommendations: DATE-.- - ----------------- ----------••--•--------_-- --- ---------------------------------------------------------••--------------------•-•--------------------••---- ----•-•------------•------------ ----------•------------------------------ --------------------------------- FINAL INSPECTION BY- -------------- ------- Date. -.------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi, California Manteca, California Tracy, California 66.9 REWOED 9.59 F.P.Co. 2M 6.6p M