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1-UK OFFICE USE: ,:•: . V - - f"- , ,i - ------ ------------------------------------------------ _._--____________________________________------_____ APPLICATION FOR SANITATION PERMIT Permit No. ------------------------ -------------------------------- (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 complianc with County Ordinance No. 549. 2p�[gyp i3 NIT" 1�.Z(J8�/AE:RE5-(5TAND LO'Cr Af 2TI0O°"c-i-fJ----- �- ---1 -- ----- -----o------- ,STI- ._ Phone-------------------------------- Owner's Name-------------H- T --*------66-oN � � Address :T .` QX ,✓Z -------------- � L�TC Contractor's Name-------------C/1R4_1 ----------------------------------------•------ •----------------------- Phone----------------------------------- i Installation will serve: Residence 2R--Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 3 ,�i� 1 Number of living units: _if##___'Number of bedrooms -3.- Number of baths __/_.. Lot size ._ACREf..r....._--------__________________ Water Supply: Public system ❑ Community system ❑ Private a---Depth to Water Table V_ ft. Character of soil to a depth of 3 feet: .Sand RG�Iravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No,flew Construction: Yes ❑ No FHA/VA: Yes ❑ No ®— TYPE OF INSTALLATION AND SPECIFICATIONS: (N075e0tiC tank or cesspool permitted.if public sewer is'aVailable within'200 feet.) - Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------.Material_________________________________________________ C.XM3TI Al G No. of compartments---- ---------------------Size-------------------------------Liquid depth ------------------------Capacity----------- ---•.� Disposal Field: Distance from nearest well.................Distance from foundation:.----..----------Distance to nearest lot line----------.._____ N e_VSTjA/& Number of lines-----------------------------------Length of each .line,------- ..----.Width of french------------------------------------ Type of filter material___________ ____________Depth of filter material------------- ------.Total length---------------------------------------/�Qt Seepage Pit: Distance to nearest well Distance-from foundation___ __ r. _. -_-_ �Q._._.___.Dpistance to nearest lot l- e_____�..: Atlin � Number of its..___-_ Linin material-_/7D1CK.....Size: Dia meter-_I_/--.�__ .___.Depth_---.---�-- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------_Lining material______------_--.-__ .______.___-_-_--- El Size: Diameter------------------------- --- -------De th--------------------- -- -- Li------------------- uid Capacity alsl Privy: Distance from nearest we11-------------------------------------------------Distance from nearest building----------------------------__.__..___.-_. ❑ Distance to nearest lot line----------------------------------------------------------------------------- - Remodeling and/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, tate laws, and .rules�andregulations of the San Joaquin Local Health District. (Sign /-"-' ay � ----------------(Owner and/or Contractor) B - -- �- �-.-- �---- y:--_-------------------------------_-�=----=-=--=------- ----- --- ------------------------- -"`-=------=----------(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----- -Tr)-?--I '--------------------------------------------------------------------- DATE----- ----------------------- REVIEWED BY - ------------------- - ............. DATE------------------------- BUILDING PERMIT ISSUED ----------- `- ::3;DATE Aiterations'and/or recommendations:-___._-------- - - ----------------------------------- ------------------- -----. -----------------•-- --------•--------------------------------- ----------------------------------------------------------------------------- --------------•---•--- ------------------- -------------- ------------------------------- ----•---------- ---------------------------------------------------------------------•-•--------------------------------.---..- ---•-•---------------------------------- -------- -------- - -- -------- ----------- ------ --- --- ------------------------------------ •--- --- •----•---------------------------------------- ------------ - FINAL INSP - ----- Date---- ---------- . SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 k",Maieltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.