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FOR OFFICE USE: --------- - -- --------- ------- ------------ 2 0 .. �r _-________________________________-______-___.___- APPLICATION FOR SANITATION PERMIT Permit No. .' _l�./.! -------------- --------------------------- ------------ (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 O ina ce No. 549. JOB ADDRESS AND LOCATIO -------------- --- --- = / --------- ----- ----- -- -- - ---- - Owner's Name-- •. - Phon t.�-3-------- Address.....................ZI------ 2_3 .A/...0.6--------��' � Contractor's Name - ----------------------�---------------------------------------------------- ----------------------------------------------- Phone............................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other A Number of living units: -- ----- Number of bedrooms -------- Number of baths __l.-- Lot size ........ __._ Water SuPPIY� Publics stem ❑ CommunitY system ❑ Private eDepth to Water Table _eft. Character of soil to a depth of 3 feet: Sand ETO"G ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [:] Adobe ❑ Hardpan E]Previous Application Made: (If yes,date_-__---._.-____.) No P New Construction: Yes V31�No ❑ FHA/VA: Yes ❑ No 55-'s TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.)/ Distance from nearest well- __Distancefrom f_ nt ------- � __ __ _____________ ________Septic Tank: � Materiipl.-. No. of com artm _---Size'/X_ X Li uid de th_--.-_-I � ---__CapacityS Disposal field: Distance from nearest well- Q.� `.._Distance from foundation----/0- _`_'_..Distance to nearest lot line--/ p Number of lines.__. _-_-_Length of each line_-----_ 9.0 -0o, 0 Width of trench.___. g �---=------ �-. --- Type of filter material____./f p g Depth of filter matenaL__....1.8 ..__-Total length _______._ Seepage Pit: Distance to nearest well.---- ----------------Distance from foundation--------------------Distance to nearest lot line_--_-._--__-_-._ ❑ Number of pits------.--- ------- __Lining material__.-_ ___--.-------.Size: 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_----------- ------------------ ------------------------------------------------------------- --------------------------- Remodeli aanci/or rep ing (describe):----- --------- ----- ------------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 r les nd of he San Joaquin Local Health District, L�Z '_- -(Owner a _�!� (Signed)-.7- ------------- - (Ow n ra ---- ---- ---------,,---- BY: 4 «►:_------(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_7 --- --6_7--------------- REVIEWEDBY - --------------------------------------------------- DATE-------- - ----------------- -------- BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------- ------ DATE�-t-.-------------------------------------------------------- Alterations and/or recommendations------------------------------------------- ---------------------------------------------------------------------------------------------------------------- ---------- --------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------- -------------------------------- ----- - - -------------------------- ---- ------------------------------------------------------------------------------------------- ------------------------------------- FINAL INSPECTION BY:.e- Com. _- ' Date------ � ------------------------------ 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.CC.