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rvt[ yrrll.0 uat: ------------------------------ ------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------- ---------------------------- ----- - (Complete in Duplicate) -------------- This permit Expires 1 Year From Date Issued �� FD f Issued 03 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, JOS ADDRESS ANLOCATfOIS (� Owner's Name.. L�1�--_ L G_ ------ ------ �7 ��J -�-- .- --.--- Phone---------------------•-- Address----------- T ` 1 `...-�� J �?Z,7 7Mfl s -- Contractor's Name-- `'- .�.. ---------------------- Phone------------.--_----------•--•-•-- Installation will serve: Residence Apartment House E] Commercial E❑ Trailer Court E] Motel ❑ Other ❑ Number of living units: j---- Number of bedrooms 3._. Number of baths -1-.-. Lot size Water Supply: Public system ❑ Community system ❑ private 91"'Depth to Water Table .. ft. Character of soil to a depth of 3 feet: Sand [!T- Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date---- --- -----------} NoZj_� New Construction: Yes ❑ No (,k]--�FHA/VA: Yes ❑ 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--------.----------Materiai---- -------_-.-- 1l)(ffFT!^f No. of compartments-------------------------Size------------------------ -------Liquid depth-------------- ----------Capacity.--------- Disposal Field: Distance from nearest well_-.SQ-----Distance from foundation----1p---------Distance to nearest lot line. 5 ►>�Tr1%G- Number of lines---------------1_.-.---- ------Length of each line------:JU-------------.Width of trench.----- V YP C P �J "� �D T e of filter mafieriaL __.: _..--.Depth of filter material 7--------__.Total length....___............. .._------_ fb Seepage Pit: Distance to nearest well___..................Distance from foundation--------------------Distance to nearest lot line_--...-.....-.. 9 ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation_-----------------Lining material-------------------------------------- nSize: Diameter-------------------------------- - Depth----------- ------------------------ ----------------Liquid Capacity------ - ------------------gals. T1 Privy: Distance from nearest well--------------- ----- ------------------------- ----.----Distance from nearest building--------------------- ----- C - -------------- ❑ 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 Count ordinances, ate laws, and rules and regulations of the San Joaquin Local Health District. (Signed)-- - -�-------- ---- `,/- ---- - ------ --------------- ------------------------ ------------------------------- - -----(Owner and/or Contractor) SY� ------------------------------------------------------------------(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- --`J-,- _ >- DATE - ~ REVIEWEDBY. ----------------- ---- --------------- ----------- ---- ----------------------- ----------------- DATE-- ---------------------------------- - UILDINGPERMIT ISSUED------------------------------------------------------------------------------------ --------------. DATE------------- ------------- - --------------------------------- Alterations and/or recommendations:-------------------------- -------------- ----------------------------------•-----------------------------•-------------------- ------•------------------ ------------------------------ -------------------------------- ---- ------------------------------------------------------------ -----•----------------------------------- -----� ----- :--- - ----------------- - - ---------------------- ----------------------- -------------------------------- ------------------------- - �. t d .4 FINAL fNSPECTION_BY: --- --- _r ---=------- .- - �- ------------- Date---------- — ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.RCO. �`