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FUR OFFICE USE: ------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ------------------------- ----------------------- ------ {Complete in Duplicate) --- --- This Permit Expires 1 Year From Date Issued Date Issued _ _��_ _`_ � Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No, 549. JOB ADDRESS AND LOCATION_____ �_ �C . __ --- J �%�— �-�� Owner's Namex 4----------1�-------11----------- --------------------------------------- . Phone- -4-2-- -= >j Z- Address__ r�✓__ -` --------------------------------------------------------- Contractor's Name__. J. — ------------------------------------------------------------------- ------------------------------------- Phone Phone------•----•----_-----_----------- Installation will serve: Residence A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ / Number of living units: Number of bedrooms --"Z--Number of baths/------ Lot size6-.___-_ ----/-___-c___�_____..__.-- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tab)e,e ft. Character of soil to a depth of 3 feet: San ❑/�rael E] Sandy Loam [j Clay Loam W Clay ❑ Adobe ❑ Hardpan E]Previous Application Made: (If yes,date//..`_ -_ ) No ❑ New Construction: Yes ❑ No FNA/VA; Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: C�� '�"��. /�? `-.0-7 (No septic tank or cesspool permitted-if public sew r is available within 200 feet.) Septic Tank: Distance from nearest well_/L� '.._Dista from foundation _ Material._'-`--'-- r'. p 7� No. of compartments_____._? __..____Size_�X .Liquid depth_-_------- �_.•....Capacit _____________ Disposal Field: Distance from nearest well/6�� '`'e@ stance from foundation.-/_c Distance to nearest lot lige_______ Number of lines___.______z�__________ __ Length of each line---/= ------�_:K__.Width of trench-------._._--_.. t Type of filter material._ _/6 _�_�-_Depth of filter material------/__, _.._. Total length---.__ ------ --------------- Seepage -----3Seepage Pit: Distance fo 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- ------------ Remodeling ----------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, Stat laws, and rules and regulations of the San Joaquin Local Health District. (Signed) /-/rte l�L!�C �...1------------------------ --------------------- ------------- -(Owner and/or Contractor) By:----------------------------------- ----•------------------------------------- ---------------------------------------------(Title)----------------------------------------... . -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., canbe placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ------ Ar - -------------------- DATE �' �D REVIEWEDBY ---------- ----------------------------------- -------------------------- ----------------- DATE----- BUILDINGPERMIT ISSUED-------------- - ------------------------------- -------------------------------------------------- DA-TE--------- ------- ----------- Alterations and/or recommendations:--------------------------------------------------------•-------------------------------------- -------------------•---.--------- -------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------- ----------------------------- -----------------•----------------------------------------------------------------------------------------- ----------------------- ----------------------------------------------------- ----------- ----------- - . .. --------- ............ ---------------------------------- ---------------------------------- ----------------------------------------------------- FINAL INSPECTION BY-------------`/u'- � L-- Date---------- r� 1 ---------------------- S, N JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.CO.