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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ---- -- ------------ -- (Complete in Duplicate) _.___________---- This Permit Expires 1 Year From Date Issued bate 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- p S /PITC JOB ADDRESS AND/��/6�C�ATIO _P�-__ // ` 14�L •r . . "` " G�.�--- ------------------------------- Owner's Name---------F--�-i---* -- - Phon � ------------------------------------------------- Address------ �r�6.� ------ � ----- - --- -- ------- Contractor's Name____ ___ ___�_ __ _ ________ - - Installation will serve: Residence Apartment House Il Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: __j.-___ Number of bedrooms .. Number of baths ___�____ Lot size ---- > Water Supply: Public system ❑ Community system ❑ Private U!IC Depth to Water Table ._ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ lay ❑ Adobe❑ Hardpan ❑ Previous Application Made: {lf yes,date--- ---------.----._} No [3r-' New Construction: Yes No ❑ FHA/VA: Yes Zr"�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 ___Distance from/foundation__._I_6---------Mahal----(7CI_11CCo. ..p______._.___._. No. of compartments---- ._Z.............$ize__t,jb_ _��Liquid depth-_�4---------- Capacity__f-7-Q-----_-_-- Disposal Field: Distance from nearest well-..+.50----Distance from foundation------ _ Distance to nearest loj line-___-_4_-4:7--- Number of lines---------------- � � --- ---.. Length of each line-_-_-____-- -3-----___-.-.Width of tTench---�----�•------------------ Type of filter material__ Depth of filter material------ -____.._._Total length-----,�,V-__ 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-- --------------------------- ---------- ----- -------------------------------------=-------------------------------------------------------- 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, St to laws, :and ru and regulations of the San Joaquin Local Health District. u (Signed)--- ---- --- -------------------------------------------------------------------------------------- ---(Owner and/or Contractor) By:------------------------------------------------------------------------------------------ ----------------------------------- -----(Title)----------------------- - (Plot plan, showing size of lot, location of systerri in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. - --� - A0.— ---------------------------------------------- ------------------- DATE------ --/9-7/ ------------------ REVIEWEDBY--------------------------------------------- ----------------- ------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------ Aiterations and/or recommendations----------- ----------------------------------------------------------------------- ----------------------------------•--------------------------------------- ---------------------------------------------------------------------------------------- --------------- ------------------------------------------------------------------------- -------------.. .- -EC Date--- FINAL INSP - ---zO R�7 r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California .