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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ........... ....... ------------------------------------------ (Complete in Duplicate) Date Issued 4.a ---------------- ----- ---.--- This Permit Expires 1 Year From Date Issued 10 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 LO_CATIO -- --------1� ..�..`�------ ._,. .�.1�/.1� 1 -------�------------------------------- Owner's Name--•--------- "---•-- ......� .�. ------------------------------------------------------- Phone_fO.v _ /- --7 Address ✓:: J5 �. •C�� --------------------------------------------------------------- Contractor's Name------- �-- ------S!-`---- --- - - -----S-------�- _�` �-�,-•--------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-1__ Number of bedrooms .-;"-- umber of baths J-_. Lot size __4 _, _ �--------------------------- Water Supply: Public system 2r--C*,Ommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [_'lay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ® New Construction: Yes ❑ No P+--T14A/VA: Yes ❑ No 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_________________Distance from foundation-------------------.Material----------------------.-------------.---__-__--_. ❑ No. of compartments--------------------------Size----------------------- ---Liquid depth---------------- -----Capacity----------------------- Disposal Field: Distance from nearest well_------.--Distance from foundation-Z_ ---------Distance to nearest lot lin ._.!>_.._....... [ - Number of lines.__.f______________ __...____Length of each line__...72 1�_._--____._.Width of trench.--_ __ �'._----_-.--_- Type of filter material____ �,rbepth of filter material._f _-_ g � �-------Total length ----------------•--_--- .. d "I Seepage, Pit: Distance to nearest well-------_--_-----'_-_Distance fr Distancefoundation__.1�...... to nearest lot line._.__f._....... Number of pits._._-.f.._._-_-_Lining material_ .!P�'�j -_Size: Diameter_ -_?_'3__'e.--__-_.Depth_--_. c= __ _-____._. 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 :-------- 1/ ! l _��' ------------------------------------------------------------------- 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 t S J aquin Local Health District. ............r (Signed)------------- � /� Q/ -- ----- --+1--.r'p� _- er d/or Contractor) By:-------- ---- ------ ------------------------------------------------------------------------------------(Title)-------•- - - ---------- (Plot plan, sho g size of lot, loc ion of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------- �="""M d y - - ----- -- ---------------------------- -----------------------------------.._._ DATE------�------------ --- --------------- REVIEWED --- ----- REVIEWEDBY----- -------------------- ----------------------- ------------------------------------------------------------- ----- DATE------------------------------------------------------- BUILDING PERMIT ISSUED----------------------•----- --------- - DATE------ -----•---------------------------------------------- Alterations and/or recommendations:--- --------�'� �' 1 ------------------------ ------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------- ------•------------------------------- -------------------------------------- --------------------------------------------------------------------------- ------------------------------------------------------------------------- - --------- ----------------------------------------------------------------------------------------------------- ---------------------------------- -------------------------------------- ------------------------------------------------------------------------------ ---------------------------------------------- ---------- ------------.-..------ ------------------- ww�c FINAL INSPECTION BY:------ ----- ------------ Date------3 / f3- -------------------------------------------- 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.