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FOR OFFICE USE: - ;: a, a _ ------------------------------------------- ___________________________ __________._ APPLICATION FOR SANITATION PERMIT Permit No. ------ (Complete in Duplicate) Thes 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. I JOB ADDRESS All LOCATION 7__ - - ------------------' r ! -- ---------> '-— '`"� _-C�_.1,� Owner's Name. -.-> c=-. ---------3-- P�a -- �- _ ` --- hone---------------------------- --------------- Address----------"---- Contractor's Name------�--- ------- ---------- ;•--•------ Phone----•-- Ph VF #. k I Installation will serve: Reside ce Apartment House❑ Commercial [ . Trailer Court ❑ Motel ❑ Other i ❑ e : Number of living units: _S_ Number of bedrooms _-" Number'of-baths Ts�_ 1_ot size _i-_____.----- Water Supply: Public system ❑ Community system [❑ Private tk Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel Sand.)Loam %Cla Loam i ❑ �Y' ❑ Y '❑' Clay ❑ Adobe' Hardpan ❑ Previous Application Made: (If yes,date______________ ---)-No ;New.Construction:_Y_es,❑�No *p.A/VA:•.Yes O -No-IN ` TYPE OF INSTALLATION AND SPECIFICATIONS: �t!�t� € (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` Se_pti i Tauk: Distance from nearest well_________________Distance from foundation___.*__-------Material __No. of comp�artments - ------------------Size_.----------------- ------------Liquid depth----------------- --------Capacity--- ------ Di osal Field: Distance from nearest well_-".�(,--"--Distance from found tion___.3_6'r"__.Distance to nearest lot line c1� 4 u•-1- f� Number of lines__ --------------- -------- _Length of each line_Y---? r__"�)Width of trench--_. �""___._-"-_ " lam' Type of filter material. 71-c��Depth of filter material---F/-8,"_"."--_Total length----- _`_ .rj"_____________"""""_-"-"- Seepage Pit: Distance to nearest well______________________Distance from foundation--------------------Distance to nearest lot iine----------------- I Number,of;pits---------------------Lining material---------- ------------Size: Diameter.----------- ---.---- Depth----------------------------- Cesspool: .-Distance from nearest well_________________Distance from foundation ------------------ Lining material--.____.__-_--_.___.-____---- ❑ S ize: Diameter---- ----- --- - -Depth---- -- - -------------- ---- Liquid Capacity gals. - 1 fivy. Disience f or m`�neare t well'" "„r'"'"te'. _ _,"�. -'""` ------ - -" -._ ._...Distance fromnearest uildin [� Distance to nearest lot line ... ----------- ------ Remodeling and/or repairing (describe):------ ----f - ----------------•-------------------------------------------- ---- ^`- -------------'------------ - - ----------------------------- ------- , jl �� }}�_ ------------------------------------- ---------------------------------------------- ----------------------- ------------ C'r- <<C-- _ c - i hereby certify that I have,prepared this application and that the work will be done in accordance wt h San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health•District. (Signed)--------------- ----------------------- ._ - ------------------------------(Owner,and/.or Sontracto, If rBy:------------------- .. - -----------------------------------------------------------------------(Title)------------------------- - ------------- ..------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F � r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- ----------------- ------------------------- --- ------------------------------ ---- DATE--- tel REVIEWED BY.» ------- DATE---)--�-Z- -- - - --------------- ------------------ UILDING PERMIT ISSUED ---------------------------------- DATE---------- -------= - ---------------------------------- ---------------------------- A#erations and/or recommendations:------_.__"_._-____ ----------------------------------------- ------------------------- -•------------- ------------------------------ --------- ------------ } --------------------------•-----•--------------•------------•------------ -------- ------------------------------------- ----------- -- ---------------- FINAL INSPECTION BY---------------- ��- Date----------- 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.P.CO. 1