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FOR OFFICE USE: ---- -------- - ------------------------ ------------ ---------------------- R -0 APPLICATION FOR SANITATION PERMIT Permit No. --------- ------- -------------------------------------- (Complete in Duplicate} r /� S _--_ . .om Date Issued - Date Issued -- is Permit Expires 1 Year Fr„ 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. JOB ADDRESS AND LQ.GTION-------------�.'�C�--- ---T7-7P_N------------ ----------- ----------- --- Owner's Name ------ f 3 ••... Phone.' . ` . X Address-.---------- ------•------- -----�'_%Oil`--------------------------- Contractor's Name-.----...-•-------- `/"'/`---��r:1 ------------------------------•-----------•--. Phone--_ ------_�� 6 7 Installation will serve: Residence ❑-"A�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms __T_ Number of baths --A-_ Lot size ------- ----------------------- Water Supply: Public system ❑ Community system ❑ Private [�epth to Water Table _/V_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay �clobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No Eg--_�N`ew Construction: Yes ❑ No [4.—f-NA/VA: Yes ❑ No Ea___ 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--------------------Material-_-_----___-.-.-___----------------.---------._-. ❑ No. of compartments--------------------- - --Size----------------- ------ ------Liquid depth---------------- -------- Capacity-------------- --- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line-_-_--_.______-_. ❑ Number of lines-----------------------------------Length of each line-----------------------------.Width of trench----------------------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest wO---/P-4-A'Distance fro foundation./e© e_.Distance to nearest lot line._!!;-._._�- Number of pits----------1__.-------Lining material--5� /__Size: Diameter..�3`� p S -- Depth ---------- Cesspool: Distance from nearest well-----------------Distance from foundation__.-----------------Lining material-------------------.____._____..__--- S ❑ Size: Diameter--------------------------- ----Depth----------------------------------------------------Liquid Capacity----------- ----------------gals. Privy- Distance from nearest well-----------------------------------._._.____.----Distance from nearest building----------------------------------.----.-. ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------- -------------------------- --------------- Remodeling and/or re airinq (describe):------ __ __ ___ s_�_. --------------------------•---------------------------------------------------------------------------------------------------------------=~--`--------------------------------------------•-------------- --------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------•--------------------------------------- s ----- --•- ------------------------------------------ ----------------------------------------------------------- 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 regulations of the San Joaquin Local Health District. (Signed)--------------------------,- - �' • �..-----7` _:� ---------------------------------- wn and/or Contractor) By:--------------------- ------------------------------------(Title} -- ----------»- . -----...... . --- ----- . (Plot plan, showing size o� of, location of system ' relation +o wells, buildings, etc., can be placed on reverse side}. FOR DEPARTMENT USE ONLY �r _ r APPLICATION ACCEPTED BY- '-- ------------- ------ ----------- --------------------- ----------- DATE------ = f�j- --------------------------- REVIEWEDBY------- ------------------------------------- ----- ------------------------------------------------------------------------- DATE------------------------------------------------------ ----- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE.----------------------------------------------------------- Alterations and/or recorn5en ations:----- - ._.. - ------ __. _ ------------------------------------------------------------ .............. ______._ ----------------------------------------------------------------- --_•-••_--•---•-_-••-•--__-_•-•-----•------------------ 1 --" -••--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL '- INSPECTIONBY:----- Cy-. -------------------------------------------- Date----- - - `_ . ------------ ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harelton Avt. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.r_O.