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FOR OFFICE USE: - ------_--_------------------------------------------- . 3 a : y 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 hereig described. This application is made in compliance with ounty Ordinance No. 549. Q137H ROr- JOB ADDRESS AND LOCATION-—------- -------U*...----- ?Qv- -----k CF•--40TH.M.� ---Pit)% E_L.N_cB_A-----------D-M- 19-19---=-------------------------------------- ----- Owner's Name------------ - ----------------------•--. Phone------------------------------------ AddressT = " fTC F' -----------------------•................................................................. Contractor's Name-----CAR�f LF-:-------------------------------------------------- =---...------ Phone................................... ---------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ --F. Number of living units: -_-_ Number of bedrooms -�... Number of baths .(._--_ Lot size ---A_C :> -------------------------------------- Water Supply: Public system ❑ Community system E] Private �epth to Water Table -0---ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam Clay Loam-E] Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_-______---________) No Flew Construction: Yes ❑ No 0—IF : 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----------------- istance from foundation--------------------Material_-_.___-_______ .---_--._._---.______-----_-__. 1P(%�T'1 �� No. of compartments------------------------ Tize-------------------------------Liquid depth-----------------------.--Capacity-----------_---------- Disposal Field: Distance from "arest well �O istance from foundation------M........Distance to nearest lot line___.___..-. 1�C, Number of lines__ ___ ngth of each line. ___. _ _.�-____.Width of trench `.-c_--_ -------- ------- t, DD Type of filter mate ria l_-...-6-CK__ pth of filter material_-_.� -..Total length--------------�5.0 Seepage Pit: Distance to nearest well---------------------- Lance from foundation--------------------Distance to nearest lot line----------------- 171 Number of pits..--------------------Lining material____..............__.Size: Diameter-----------------------Depth___-_--._____--.._._.-.--__ Cesspool: Distance from nearest well-----------------Distance from foundation._.-----------------Lining material-_______---.-______.._-_-.-_________- 7 ❑ Size: Diameter--------------------------------------Depth----------------------- ------._Liquid Capacity----------------------------gals. .5. Priv Distance from nearest well--.---------------------.----------.--------------Distance from nearest building — ❑ Distance to nearest lot line---------------------- -- ---------------------------------------------------------------------------------------------------------- Remodeling and%or repairing (describe):----------------- ----------------- ------------------------------------- --------- -------------------------- ----------------------------- •4c/ d:------------------------------------------------------------------------------------------------------------------------------------------------ ----------------------------------- ------ G --------------------------------------------------------------------------------------------------------------------------------------------------------------------------=--------------------------------------------------- P -------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------- 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 nd regulations o .the San Joaquin Local Health District. (Signed) eF ----------------------------------- -----.(Owner and/or Contractor) 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 APPLICATION ACCEPTED BY------------- ------------------- ------------------------------------------- DATE------------ -` 5---------------- REVIEWEDBY------------------------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ t BUI'LkING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ --------------- -----------------I ---,-- - ..... }--------------- ------------------ ----- ---- -------------- --------- ----------------------- FINAL INSPECTIO - Date--------5------- � .._ --- - -- SAN' .IOAOUIN 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.