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FOR OFFICE USE: --------------------------------------------------------- ------- APPLICATION FOR SANITATION PERMIT Permit No. -�1 (Complete in Duplicate) ------ ----- ------ - ----- -------- -- Date Issued ,l ----------------------- _ - :- _--------- 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�rdiinance No. 549. JOB ADDRESS AND L�ATION/ 6.3__ -f. "-=/---------A_� _F-D�-------------------------------------------mr Owner's Name------------ _� �7 `---------�CN_Q��. --=---------- -. Phone------------------------------------ Address----------------------3.7!T...--------- � G------/ �I S-r`--------11EI Q_v�=RT©�V'".-------•-----ORE _.N--------•- Contractor's Name-TKEZ . ....S .T.`.« ___ -r_ -_ --- ------------ ---•----------• ------ ----------- Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer-Gaart Motel ❑ Other ❑ Number of living units: ---I--- Number of bedrooms _Z7 Number of baths _j..... Lot size ----------Z-... }CS S------------------ Water _ ____ _Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 1Q_ 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 New Construction: Yes ❑ No ?r---FHA/VA: 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_-_570----Distance from foundation-----ta____._.Material_-__cow- s-m-rT--------- No. of compartments___-Z_-___...__Size___if___/ _)0_x_5___.Liquid depth-_-__7X-A -----Capacity...J7-0_ Disposal Field: Distance from nearest Distance from foundation-----/0........Distance to nearest lot line......?._: _... Number of lines----------I----------------------Length of each line---10.0---------- ,_.Width of trench------- /--"I ---t------- . Type of filter material___ O.G K, Depth of filter material-------147---------Total length________________ ___-_____-__ Seepage Pit: Distance to nearest well----- ----------------Distance from foundation--------------------Distance to nearest lot line----------------- El 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-------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/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 haws, and rules and regulations 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---------^-�1-_ __(Zt_c ------- --------------------------------------------------------- DATE---------- ------------------- REVIEWED BY--------------------------- ------- ------ DATE------------------------- ---------------------------------- BUILDINGPERMIT ISSUED---------------------------------- ------------------------------------------------------- DATE---------------------------------- ------------------------- Alterations and/or recommendations------ -------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------ ------------------------------------------------------ --------------------------------------------------------------------------------------------- ---------------- ------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------- .------------- FINAL INSP ON B - -- - -- ----------- 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.CO.