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rVK Urrll.t USt; ��--'?---------------- ------------------------------------- 3 zo----- APPLICATION FOR SANITATION PERMIT Permit No. -------------------------- - ------------------------ --- {Complete in Duplicate} ----------------- This Permit Expires i 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. JOB ADDRESS AND LOCAT �- `v._------____ ---------------------- -------------------•----------I---------------•-------------- ----------------------------------- Owner's Name------ Phone '474 ------------------- - -------------------- Address---------11 ------- -----------------------•-----------------------------------------------••---------------- ----•---•------------------------ Contractor's Name--- --------- --•----7 5----------------- -------------------------------------------------------------------------•--- Phone....... ---- ---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other E] Number of living units: ----L Number of bedrooms -,2._- Number of baths -_1---- Lot size l Dox-_.Z-op•...._ - ------------•------------ Water Supply: Public system [! Community system ❑ Private ❑ Depth to Water Table __4�rft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe R--'Hardpan ❑ Previous Application Made: (If yes,date._-----------------) No P�r New Construction: Yes ❑ No f FHA/VA: Yes ❑ No fr-� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weli-- -------Distance from foundation-ZG-------------.Mterial_._cin's,41. L� No. of compartments......Z------ --- ....Size--------3-A-6-x -C...Liquid depth....?------------------Capacity---rDB---------- Disposal Field: Distance from nearest weli-----------------Distance from foundation-----------------.-.Distance to nearest lot line----------------- E�5 Number of lines-----------------------------------Length of each line---------.-.------------------Width of french------------------------------------ Type of filter material---..------_.-.--.------Depth of filter material_.---------_----_--_--Total length------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----_.--.-.-----_ ❑ Number of pits--- -------------Lining material---------- ------------Size: Diameter-----------------------Dept h--------------------------------- Cesspool• Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------- El Size: Diameter--------------------- ---- ---- ------Depth------------------------------ ---------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well--------_--------------------------------------Distance from nearest building---._.____._.________________._______._. ❑ Distance to nearest lot line-- ------------------------------- --------------------------------------------------------------------------- Remodeling and/ . (d (describe :-----C.11 -- - - -.-- kcl. . / ,Art ----�`'-�-------- �d°�a. ---- --------- ------------------ I-------------------------------•--------------------------- --- ------------------------- ------------------------------------------------------------------------------------------- -------- 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 ru s andregula io s of t e San Joaquin Local Health District. (Signed) ------------------- - --------------------------------------------------------------------------------(Owner and/or Contractor) By:---------------------------------------------------------------------------------------------------------------------------------(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 APPLICATIONACCEPTED BY------------- ----- -�., ---------- DATE----------lJ ----- -- --BY--------------------------------------------- ----------------------------------- ------------------------------------------- DATE---------------------------- ------------------- BUILDINGPERMIT ISSUED------------- --------------------------------------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations--------------- ---------------------_----- - --------------------------------------------------------------------------------------------------------------- ---------------------------- --------------------------------------------------------------------I---- -------------------------------------- ------------------------------------------------------------------------------ --------------------------------------------------•--------------------------- --------------------------------------- ----------------------------------------- ---------------------- ------------------- ------------ -- ----------I- ----------------------- ----- FINAL INSPECTION BY:-----------60'x_..,---C 4-- Date---.....----.. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxetton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.