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FOR OFFICE,USE: k')( �\ APPLICATION FOR SANITATCON PERMIT Pwmit No. . ------------- ------------------------ (Complete in Duplicate) -_-._____--_-_-_.__ This Permit Expires 1 Year From Date Issued Date issued .,--Z _�.._._...T.. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. O JOB ADDRESS AND LOCATION..-_ dinance No. 549. .lI __l__. _. This application is made in compliance with County Owner's Name--------0f (�"� --- Phone /.3I_ .�,.2 s-V p - - - ----•-----•------- Address ,7 ----------- 9T 6 Contractor's Name--------•--L�/- -� ----•--•----- --- Phone..' 6••-•� , Installation will serve: Residence 0�` Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.----- Number of bedrooms -------- Number of baths -------- Lot size __6/_ �_ a_ _____________________ Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table --6-e?ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam�VNo lay ElAdobe [Hardpan E] Application Made: (If yes,date._-----__--.-_-.._.) No P7 '- New Construction: Yes ❑ FHA/VA: Yes tj`" 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__A�............Material_ ------------------------ No. of compartments------'�.-_---___-___Size-----, -------Liquid depth__'f--..--_-_----_Capacity...SPPP4. 10 Disposal Field: Distance from nearest well-----1--..--.._Distance from foundation-—�_--_.---.._.Distance to nearest lot line____S_�._. Number of lines.---------Q._-_--------------------Length of each line--- --------------------Width oftrench---- -------- of filter materialCoL'f__--._Depth of filter material----1�_�'`'-..__.___-Total length--------��V_.�____________________ Seepage Pit: Distance to nearest well- .............Distance from foundation----/iq....._...Distance to nearest lot line--- Number of pits-_-_�____-..____Lining material__-�4_'- __-._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------ ------------------ ---------------------------------------------------------•--=------------•----•------- -------------------------- 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 laws, andruI stand regulations of the San Joaquin Local Health District. �� (Owner and/or Contractor)ned)-------------------------------- ---------- -- --------------- �----- ----------------- By:------------------------------------------------------------------------------------------------------------------------------------(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 APPLICATIONACCEPTED BY---------------' --`----------------------------------- ---------------------------------------- DATE--------YfP-- _6/---------------------------- REVIEWEDBY------------------------------------------------------------------------------------------------------- ------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------- ----------- ------ DATE------------------------------------------------------------- Alterationsand/or recommendations---------------------------------------- ----------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------ ---------------------- -------------------------------- ---------------------- --------------------------------------•---- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------- ------------------------------------ --------------------------------------------------- -------------------------------------------------------- ---------------------------------- ------ FINAL INSPECTION BY:....�'------------- -- .... ---------------- ....___ - Dete � V -------------------------------- 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.