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ivR vrrf�.c UJC: ------------ ------------------ ------------------- --------------------------- ---------'_.___.__ ------------------ APPLICATION AOR SANITATION PERMIT Permit No. � .. --------------------------- ------------ ---------------- (Complete in Duplicate) ------------------------- This Permit Expires 1 Year From Date Issued Date issued _-'1 — 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 Ordinan No. 549. JOB ADDRESS AND CAT ON ----------STB e 1j`I'L 0/7 Owners Name------ Phone ------ -.._. Address----------------------- ------------------ Contractor's Naml�j �- 1 #----- t------` . -----------------------------------••--- Phone...�:C Installation will serve: Residence partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _T_ Number of bedrooms __ I�lumber of baths __l___ Lot size '._X_l�a- - _________________ Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table _...__. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date-----------__-------j No ❑ New Construction: Yes [] No [4,—Fl�A/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se S Tan Distance from nearest well________________Distance from foundation-------------------Materiaf_._-______ No. of compartments-------------------------Size---------------------------- ---Liquid depth.---------------- --------Capacity---------------------- Dis sal F Ids Distance from nearest well-- -;kms-Distance from foundation----� _!------Distance to nearest lot Number of fines___.__.[-_ Length of each line____�Q_�_-----__--.Width of trench___-� Type of filter material - _ Depth of filter material___ �- �� Total length---------------------------I & Seepage Pit: Distance to nearest well._.__ -_________ ___Distance from foundation___________________Distance to nearest lot line----------------- 00 0 Number of pits----------------------Lining material--.-_- --- ------------Size: Diameter-------------- --------Depth--------------------------------- 6 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 and/or repairing (describe) -------------•--------- ----------------- ----- ----------- -------------------------------------•------------ --------------------------------------------------------------- --- -------- ----------------------------- , ---------------------------------------------------------------- ------------------------------------ I hereby certify that I have prep red this application and that the work will be done in accordance with San Joaquin County ordinances, t to law , .and rules and regulations of the Sanquin Local Health District. (Signed)- �L(-� 1+� -t-(.__.j t Jf - ------ - -- - --- - --------------- By:--------------------------------------------- - -By:---•---------------------•-------------.-•------ ------------------------------------ itle)--------- - (Plot plan, showing size of lot, location of system in relation to well uildings, etc., an be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------- REVIEWEDBY----------------------------------- --------- -------- --------------------------- --------------------------------- DATE ------------------------------------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------------- ------- DATE -- - -- ------------------- Alterations and/or recommendations:-------------- --------------------------------------------------- _______________. ------------------------- ---------------------- -- ------------------------------------------------------------------------------------------------------- 11�61 FINAL INSPECTION BY:.,--- ----------- Date----------- s%a?: ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.