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FOR OFFICE USE: -- 14 -------. ----------- _______________2=_ --- -__ �:�---.---- (� APPLICATION FOR SANITATION PERMIT Permit No. __ ._/5___ --------- ------------ ----------- --- ---------------- (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 compliance with County Ordinance No. 549. JOB ADDRESS AND CATION -A--------- f - Owner's Name------- / _ __ Phone.................................... Address d ------ i � -------------------------------------------------------------------------------------------------------•-------------------------------- Contractor's Name---------- 'Z --•-•-•------------------------------------------------------------- •---------- -•-•---------•--- Phone................................... Installation will serve: Residence Q' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _,/---- Number of bedrooms-,-1..__ Number of baths _/____ Lot size ______ ____________________ Water Supply: Public system Zj- Community system ❑ Private ❑ Depth to Water Table 8'#�__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam`❑ Clay ❑ Adobe IT-Hardpan ❑ Previous Application Made: (If yes,date--------------------) No R New Construction: Yes ❑ No W�" FHA/VA: Yes ❑ No 8-- 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-__t-0_--__-__.Material- ------ _.__.._�_�_--_._,--_--:,_. No. of compartments------_�-_________Size-----_. _�X_'s'fif `Liquid depth--------- p --�'C[? Ca aci 1 --- Disposal Field: Distance from nearest well.--- Distance from foundation----f A--------- to nearest lot line-_:------------- ®'" Number of lines------------/--------------------Length of each line_--__------Y_o__`_______.Width of french_.:__:_Z--_--.----_-_-.-------- Type of filter material-__-.RtG��.___Depth of filter material--_..�rf_r____Total length-- _____ __----------------------- / Seepage Pit: Distance to nearest well___x-------------Distance from foundation__.!.a-----------Distance to nearest lotfine_,6,.-_r_-___.._ [ice Number of pits..---I-------.__---Lining material---OFAC&------Size: Diameter--_/4_4------Depth_._., -------�_r'�----- __ 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 - - In -- - Remodelingan / rep g ( scribe):-- -------------- ------------------------------------------------ -----------------•------------------------------------ i. .. --------------------------------------------------------------•---------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. (Signed)----- - - - -------------------------- ---(Owner and/or Contractor) BY: = J ----(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 j APPLICATION ACCEPTED BY----- 1 l UC-1-------- ---------------------------------------- DATE-------- --------------------------- - REVIEWEDBY------------------------------------------------------------------------------------- --------- ------------------ ----- DATE------------------- BUILDINGPERMIT ISSUED-------------------- -------------------------------------------------------------------- DATE--------------------------------------- - Alterati ns d/or recomm dations:-______________________ �_ --- - -A- P"`�� 'r�c P --� ----- 1 ----------------- - ------------------------------------------------------------------------------------------------------------------------------------------------------------/ -; - ------------------------------------ -------------------- FINAL INSPECTION BY:----- ` --------------------------------------------- Date------"�� d 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.C C.