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FOR OFFICE USE: _____________________________-- •______._.-_.__-__________ APPLICATION FOR SANITATION PERMIT Permit No. f_--`.� ----------------- ---------- ----- - (Complete in Duplicate) -- - -- ................... ............................... This Permit Expires 1 Year From Date Issued Date Issued - ___ 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. �Q,�J p�3 _nip,—SID l MB ADDRESS AND ATIO.._N� ,-J - rea - -- -- -- -- Phone----..-----. -- - `, Owner's Nam�el- ,;_;L4511 -- --- --••- ----- --------------- - -- ----t -;--- Phone--.•-------- ------------------ --- Address..... . _ 1 -- Contractor's Name---------�c.. —4. -o�F� Phone. Installation will serve: Residence [?Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. _.-_._ Number of bedroorrii _Number f baths I... Lot size ___��! S��r�-________________________ Water' Supply: Public system El Community systems❑ Private [Depth t Water Table -------- ft. a: Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote___----------- No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: E (No septic tank or cesspool permitted if public sewer is available within 240 feet.) i' Septic Tank:- Distance from nearest well_________________Distance from foundation-------------- Material___-.____--.___.._.-_____.._________.._---..___. ❑ f , : No. of compartments-------------------------Size----------------------------:---Liquid depth----------- --------------Capacity----------------------- n ! < . .V . Disposa F field: Distance from nearest well----- from foundation___ ___� Q_____._Distance sto nearest lot' line----�_a_C!_-.-_______.. Q � EK Number of lines------------ --------- ---------Length of each line-------LOQ._`-____ -- Width of trench-----�-i�----------------------i Type of filter material____.__ ___t/_-- ______Depth of filter material------/f.'__ -------Total length-----40-t-?_i-____---_-______.___._! p g ___.Distance to nearest lot line.................: 5ee❑l erPit: Number of pits rest well Lining material Distance -from foundation Diameter-" "'^- = -._`"DepFh--- ------------------------ 4 Cesspool: Distance from nearest well .-.____-_.------Distance from foundation-------------------Lining material-....._-._._--_--------_____________� ❑ Size: Diameter--------------------- -------------De th-------------------------------------------------µ.Liquid Capacity -----------gals. Priv y:y Distance from nearest wel!-----�__-------_---------------- Distance from nearest;building-------._____._________________.___.__..., ❑ I Distance to nearest lot line. = --c'-------------- ----- ----------------------:�:-------------------------------------------------------- Remodeling,and/or repairing (describe):-----------I ' f ------------- -------------- - - ------------ ---- - ------------------------------ ---------------------------------------- - ----------------------•---------------- ------------------------------•-------------------------------- ------- --------------------------------------------------------------------------------------------------------------------------------- --------------------'------------------- -- k I I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County Rordinances, Stat a and rules and regulations of the San Joaquin Local Health District. (Signed)---- ---I --------------- ------ and/or Contractor) By:-- (Plot :-- (Plot plan, showing size of lot, location of system in rela on to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---ffT ---------------------------------------------------- DATE----- f -- ---- --------------------- REVIEWEDBY-------------------------------------------- -------------------- ----------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-------------------------- ----------------------------------------------------------------- DATE--------------------------------- --------------------------- Alterations and/or recommendations:--------------- ----------------------------------------------------------------------------------------------------------------------------------------------- ---------- ---- --------------- - ----------------- ------------------------- ------------�----'----.._.......----------------------------•--------------------------------------------------------------------------------------------------------- -- /5= = - - � - FINAL INSPECTION BY:.--- --- ---------- Date------`-------------- - --. --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.