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FOR OFFICE USE: 7R 93 y - ------------------------------- ------------------------------------------------------ --- APPLICATION FOR SANITATION PERMIT Permit No. 1.17,1--•l.--3 (Complete in Duplicate) Date Issued ---- -_-�-5 - -------------------------------------------------------- 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 +he work rein described. This application is made in compliance with County Ordinance No. 549. f4tea Fcw 13� ` JOB ADD�SS AND LOCATION---O�----7IJ. �- - - s� �`'�------ Owner's Name------ .rj _ ------------------- ------------------------------------- Phone-----------------------------••---- Address_-•------ K- !- Contractor's Name-------- ---------------------------------------------------------------------•---------- Phone................ -------.---------- Installation will serve: Residence [R-"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r� � Number of living units: --/--- Number of bedrooms _u_-- Number of baths -�- Lot size ---�_ .__ ___r'_____________________ Water Supply: Public system ❑ Community system ❑ Private U�/6epth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ CClay Loam ❑ Clay dobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote____----------------) No [New Construction: Yes U?-No ❑ FHA/VA: Yes Z+--"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.] � / A Septic Tank: Distance from nearest well__/"---Distances from foundation--- -_-_-----Mateivl ----------- No, of compartments---- Size XX-,;.e _Q. q p. � -------Capacity_/�.f�p _ ,�/ � �i uid de th_---_ _-/ - ---- Disposal Field: Distance from nearest well_/4?.Q.._Distance from foundation___1p___._-.Distance to nearest lot line/G7f1____ U?/ Number of lines___ 4Aikepth Length of each line____ea_.�----------_-Width of trench____2/___ _--------______._ ... --------- Type Total len th___7 e of filter material of filter meterial___��_-__..__ g �------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line______._____--_. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter.----------------------Dept h--------------------------------- Cesspool: Distance from nearest wei4-----------------Distance from foundation---.--------------- Lining material----------.-------------------------- 1-1 Size: ---------------❑ Size: Diameter- ----------------------- Depth--------------------- -------------------------------Liquid Capacity- :--------- ----------------ga€s. Privy: Distance from nearest well-------------_-------------------------_---------Distance from nearest building------------- _________________--__..._. ❑ Distance to nearest lot line----------------- - ------------------------ ----------------------------- ------------------------------------------------------------------ Remodelin 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 laws, and Fules and4regu�llatiooff +he San Joaquin Local Health District. Signed------ ... ---- Contractor] -tet B [Title]- ' - -------- .- - �1.G� ----------- ---- --------- (Plot plan, showing size of lot, location of system in rel n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY --------------------------------- -- ------------------------------------------------------ DATE------------------------- --------------------------------- REVIEWEDBY------ ---------------------------------------------------------- - -------------------------------------------------------- DATE------ -----...-------------.-------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------- ------------------------ DATE------------- ----------------------------------------------- Alterationsand/or recommendations-------- - --------------------------- --------------•------- -----------------•---------------....----------------------------_---- -----------I-------------- --- ----- ---------------------------------- ------------------------------------ -- ------------------------------------------------------------------ ------------ ---------------------------•------ -------------- FINAL INSPECTION BY . --- --- Date---- ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.HaWton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O. w -