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FOR OFFICE USE: -------- -- ----- - ---6.j-_----------------- ---------- APPLICATION FOR SANITATION PERMIT Permit Nq ll _ r - ----------------------- -- ------------------------- (Complete in Duplicate) Date Issued 1-2 This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein descried. This application is made in compliance with County Ordinance No. 549. 1 JOB ADDRESS AND LO ATION_ Cr -- a .- r ---------------------- ------ Owner's Name___ --- -------- -------------•------------- --------- ------------- = e.-•--• ---------------------------------------------- Phon ------------------------------ Address------------------ i - -------------- Contrador's Name-- --- ------ -^-----•-•-•--•---------------------------------------------------------------------------------------------•--- Phone....._..-----------•----•---------- Installation will serve: Residence Apartment House ❑'-. Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � r Number of living units: ----- Number of bedrooms 3--- Number of baths _off-__ Lot size ___ _______________ Water SuPPIY� Publics stem Dd Community system El Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2f Hardpan ❑ Previous Application Made: (If yes,date...... .............) No 'v New Construction: Yes X No [I, FHA/VA: Yes E] No E]TYPE: OF INSTALLATION AND SPECIFICATIONS: k (No septic tank or cesspool permitted if public sewer is available within 200 feet.)` Septic .Tank: Distance from nearest well__�?.3f% --Distance from foundation__._�O Matorial �G C � TAUK No. of compartments_____.._--_ ___._____--:_-.Liquid depth_______________.---------Capacity__�Q0._GA\- -------..Size--------- - Disposal Field: Distance from nearest well-.N1%_____Distance from foundation----- ----------Distance to nearest foot line__��________ Number of lines_____________L-- -------.----------Length of each line___-___&9.....-- -__....Width of trench------449"_____6+��.i_Z Type of filter material-------------_____---_Depth of filter material-__.____-- ------------Tota4 length------------- U_ --_-____________._ h 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 well-----------------Distance from foundation------------------- Lining material----.--------------------------------- El Size: Diameter.--- ----------------------De,pth----------------------------------- ----------Liquid Capacity- - •----------------- gals. w.r Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.__._...______-_------_-________._._-_--- t ❑ 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 laws, and rules and regulations of the San Joaquin Local Health District. r _--.-.._____--_--------------Owner and/or Contractor(Signed)-------��=---- ( � ) `BY:-----------11311%,--- ---------------------------------------------------------------------------------------------------(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 ^ r� APPLICATIONACCEPTED BY------ ------------------------------------------------------ DATE----- _--L�_9T- ----- ----------------- REVIEWED BY------------------------ -- DATE BUILDING PERMIT ISSUED _ ----------------------------------- DATE------------- - ------- - Alterations and/or recommendations _ 4°!r+_PLG-G...IZ,T5� 1_�?twk- ---- ----- ---- p►- ----' ----- -Q� '----- --� --- ------ P -— ' --r-------------------------------- Q ----- 9 p FINAL INSPECTION BY:'.�'.. ------=--- ----------- Date -1,.- .. -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Mazelton Ave. ., 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California