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FOR OFFICE USE: --------------------------------------------------------- v� 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 de crbed. This application is made in compliance with County Ordinance No. 549. 4AT"RC � � � JOB ADDRESS AND LOC TION. _� _P .- T h.�/g �' �'►-�t C--------../AT-Hh-��------ )� , Owner's Name---•------- k_. ----•--•-..... - - N--- -- Phone-----•----------- ------------------------------------------------------------------------ AddressT_E, .. x �'.�......-- ----=------' / 1-�R C '...:.................................................. Contractor's Name------�.1q R_& �-1-L' ----•----------------•------•--•------••- ------•----.-_-------------------------••--------------•---.---- Phone................................... Installation will serve: Residence [Apartment House ❑ Commercial E] Trailer Court ❑ Motel E] Other ElNumber of living units: -]--_- Number of bedrooms 3--- Number of baths ---/--- Lot size ----ALR�______________________________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table .1'_ ft. Character of soil to a depth of 3 feet: Sand 23-'Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date------ -------------) No 2----New Construction: Yes ❑ No ja--FHA/VA: Yes ❑ Nom-' 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----------------.-------------------------------- "b-n _--___--_--__--_-_._______----."b-n N &- No. of compartments--------------------------Size-------------------------------Liquid depth--------------- ---------Capacity----------------------- Disposal Field: Distance from nearest well__.___�'� .-Distance from foundation-__r 0.-....._..Distance to nearest lot line...t) .... V, �c(577o4C- Number of lines-__._____��- ----------------Length of each line-_��7_�a-7----Width of trench._.,_______�'�____.________ "y- Ay(�Y Type of filter mate ria l__ D__r �_.__Depth of filter material ....Total length--------5 -_._..____.._ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line-----._-.__-_-... ❑ Number of pits----------------------Lining material----------------------- Diameter-----------------------Depth-------------------------------i0 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------.-------..___..-----------I b.1 ❑ Size: Diameter--------------------- ---------------Depth-------------------------- -------------------------Liquid Capacity-.--------------------------gals. -+- Privy: Distance from nearest well------------------------------------------------- from nearest building______________-_______--_--__-_.-__--. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------•---------------------------------- C Remodelingand/or repairing (describe):----------------------------------------------------------------------------------------------------------------------------•--------------------------.1 ---------------------------------------------------------------------------------------------------------------------------------=----------------------------------------------------------------------------------------- ------------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)------- `/ 1 ------------ ---------------------------------------------------------------------(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- _ _�J_-____-___.___.--___--_-_-_ ----------- - j --------------------------------------- DATE-------- --------------- REVIEWEDBY------------------------_-------- ------------------------------ ---------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------- --------- ------------------------------------------------------- ---------- DATE--------------------------------------- --------------------- Alterationsand/or recommendations---------------------- ---------------------------_--------------------------------------------------------------------------------- -------------_---•------- •_------- ------ --------I--------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------- -------------•-------- ----------- ----- --------------------------------------------------•-------------------------------------------------------- ---------------------- ----- -- - - - -------•------- -- -- -------- l--------- FINAL INSPECTI BY. . �-- ------- - Date-.----------�� '�iL [�'f�------------------------------- 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.