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FOR FFICE USE: --------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._ -_b.f 5� --------------------------- -- ---- ------ -------------- (Complete in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued __ _=_ Application is hereby made to the San Joaquin Loca! Health District for a permit to construct and -install the work herein described. This application is made in compliance wiityt��h County Ordinance No. 549. JOB ADDRESS AND LOCATI N--- -�a--_ �� 1 Owner's Name------,/&I-IdT-S 1i�-�. Phone---��_��/f •-- -••---'--- ------ -- -- Address-----------•----- ---- -'---- �� ---------------------------------------•---------•-----•---•-••--------•----... Contractor's Name---------------------------- G( /?---------------------------------------------------------------------------------------- Phone-_-------------•------------------. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trainer Court ❑ Motel ❑ Other Number of living units: __.L--- Number of bedrooms __-'2-,Number of baths ---1--_ Lot size _____Fa��`_/�V_-_ _____________________ Water Supply: Public system 9--community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand Loam E] Clay Loam El Clay C1 Adobe Hardpan ❑ Previous Application Made: (If yes,date....................I No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No EZ_-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic TaA: Distance from nearest well-----------------Distance from foundation--------------------Material..____.________.__-_..._____________....________- �Y-s1` 111 No. of compartments Size Liquid deP.fh--------------------------Capacity------------------ Disposal Field: Distance from nearest well----1 .-Distance from foundatior___.�_ S--Distance to nearest lot line___ �JA%7 Number of lines______.___ __ Length of each line__ _: _ D __..Width of trench_____.._ --------------------- Type �____________________ T e of filter material-:_'� � �De th of filter material______r�---------._Total len length 'fr____________________ _ y pp �3 { Seepage Pit: Distance to nearest wet!--------------_-------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-____._________..____.._____.__-_ 1n ❑ Size: Diameter--------------------- ----------------Depth------------------------------ -- ----- ------------Liquid Capacity----------------------------gals. ' Privy: Distance from nearest well---------------------------------------------- --Distance from nearest building.---------------------------_.____.____._.� . ❑ Distance to nearest lot line-- -- -------------------------------------- - --------------------------------------------- -------------------------------- A Rem ling and or repairin describe}:__/_G �� f _ ,--------1.f.� �`---� ------------------------- -�---------- --------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to laws. �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.__------_ A ____________ DATE__ ---- ---- --------- - ---------------------------------- REVIEWEDBY--------------------------------------------- --------------------------------------- ---------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------- ------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations-------- ------- ------------------------------------•------------------------------------------------------------------------------------------------------- -- ------------------------------------------- ----------- ------ ------ ----------- ---------------------------------------------------------•----------------------------------------------------------- ------------------------------------------------------------------------------ ---------------------------- ------------------ --------------------------------------------------------------------------------------------- ------------------------------------ ------------------------------- ------ - - FINAL INSPECTION BY:. G L�'�------- Date �9_Y SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellen Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Cn.