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FOR OFFICE USE: - -------------------------------------------------------- ------- ------------------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. AZD.0 ---------------- -------------------------------------- (Complete in Duplicate) --------------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued ___------------�__-4�,` Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work hereinOcnbecl. This application is made in comp)ante with County Ordinance No. 549. �F �p '�-� / fir' JOB ADDRESS AND LOCATION- �y Owner's Name 1�------ ------------------------- ---------------. Phone------------------------------------ Address -- ----- � � �---------------------------`1e'�.._�•16'-�--F D13F------=--------------------- Contractor's Name-----------0_VJ1V_ -.•----------------------------•-----------------•--------•- -----•--------------- --------•------ Phone----------------------------------- Installation will serve: Residence © Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ C1'1V Number of living units: I----- Number of bedrooms __t_._ Number of baths -----!- Lot size ___._ _'------___. �/ _ Water Supply: Public system E] Community system R Private EJ Depth to Water Table/3-ft. Character of soil to a depth of 3 feet: Sand 0' Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: Of yes,date--------------------) Nom}`" New Construction: Yes FL] No ❑ FHA/VA: Yes ❑ NOS] 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---14.0 Distance from foundation__,/.C---' ___.Materia------ i _�4'_ Jt� T [� No. of compartments--__ ?-------. _ Size____A3C'__r!C. __-_-Liquid depth_._ __:_._ ------Capacity ?r, �4 __- Disposal Field: Distance from nearest well--- Distance from foundatio __ i Distance to nearest lot i C--------- Number -___ v• Number of lines.__ t" _ ____-__-Length of each line_--_ ` Width of trench--_.____ ------- --- ----- 6 Type of filter material---R0.c#'-'_-Depth of filter material-.___ __ ..---- Total length_________________________U _____-- --- .1� Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line________________ 1, ❑ Number of pits---.------------------Lining material---------.------._-----Size: Diameter_--------------------Depth-----_--------------------------- Cesspool: Distance from nearest well-------------.---Distance from foundation--------------------Lining material------------------------------------- 0 ❑ Size: Diameter----- -------------------------------Depth------ ---------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.______--._______-____________________ ❑ Distance to nearest lot line ------------------ Remodeling and/or repairing (describe):---------------------------------------- ------------------------------------------------------------------ --------- �. ----------------------------------•----------------------- ----------------------------------------------- ----------•-----------------------------------•--------------------------------•------------•------•------------------------------------------------------------------------ %A ----------------------------- ------------------------------------------------------------------------------------------------------•----------------------------------------------------•----------------------------------- .• I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County L4 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-------------- f - ' ------ (�•----------------------------------------------------- ----------(Owner and/or Contractor) / BY: ------------------------------------------------------------------------------------------------------(Title)-------------------- fo (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY T_ 7 -1-_ APPLICATION ACCEPTED BY----�r__f�!G------------------------- ------ ------------ DATE--------- _-/ -- REVIEWED BY - ----------------------------------------------------- DATE BUILDING PERMIT ISSUED-------------------------------------------------&-------------------------------------------------- DATE - W Alterations and/or recommendations:------------n....... --------------------- ------------------------------------------ ---------------------------------------------------- ------ -- - ----- --------------------------------------- ------------------------------- ------ ----------- ---•_---------------•--------------------------- ---------—------ -------- --------------------------------------------------------------------------------------------------------------------- - ---Z- FINAL INSPECTI :.--- - - -- --- --- ----- ------- -- -------- Date---- ------ C-- (-. -_ :. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 'i Stockton,California Lodi,California r Manteca,California Tracy,California F.P.C O.