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FOR OFFICE USE: ----------------------------------------- ___--__. �AP LICATION FOR SANITATION PERMIT Permit No. ... 9..., 7 ------------ ------------------ ---------------- (Complete in Duplicate) Date Issued _..________________ ----------------- ___________ This Permit Expires 1 Year From 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 LOCATION,�•�1e�__. . �,/O r ' a '��,. w Owner's Name----. -----------7q.A1e,-A ----------- ---------------------------------- ------------- Phone------------------------------- Address------------_f l r = ...� 13 Ca x ,! ......-------mTC 4 Contractor's Name---- --------------------------------------- ----------- •--------------------------••---- Phone................................... Installation will serve: Residence M—Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __:I___ Number of bedrooms _1--- Number of baths __/_-_- Lot size ------------------__--_-___---_-_-.--_____--:_-______-_-_. Water Supply: Public system ❑ Community system Pff--Private ❑ Depth to Water Table A ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date---.-----__.-------) No C!�-`New Construction: Yes Jff No ❑ FHA/VA: Yes ❑ No [R — TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T k: Distance from nearest well__`T__6__Distance from foundation_1B_ -------Material--- (t 'i ----------------- No. of compartments. 2 - .....Size---- >iS�._�_ Liquid de th__----5f-----------------Capacity Disposal Field: Distance from nearest welltSV_ -------Distance from foundation---l-6___----------Distance to nearest lot Number of lines------_----------------------------Length of each line------ 6------------------Width of trench-.-Z4.._-_.._____.----------- . Type of filter mate ria lTo_-_C_(-______Depth of filter material---/&--------------Total length__6__4------------------_--____---- Seepage Pit: Distance to nearest well--------------_-------Distance from foundation--------------------Distance to nearest lot line--------......... ❑ Number of pits______________________Lining material__--_ __ ----------- 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, and rules and reg lations of the San Joaquin Local Health District. (Signed)-------------- ----- ------------ ------------- ------------------------------------ ---------- ----------------------(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----------T-t-Rt O------------------------ --------------------------------------- DATE----------2� '1 �� r----------- REVIEWEDBY--------------------------------------------- --------------------- ---------------------------------------------------------- DATE-------- ----------------------- ---------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------------- - Alterations and/or recominendations----------------------------------------------- ------------------------------------------------------------------------------------------------_---------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------- --------------- ------------ ---------------- -------- ------ --- ---- ---------------------------------------------------------------------------- ------------------------------------------------------ __. .----------- --- ---------------- -------------------------------------------- - FINAL INSPEC N BY _ '� z Date--- ----------- l-9- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 C.