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i vii L/I FIL-C UJC: r---- --------- -__. APPLICATION FOR SANITATION PERMIT Perm7'f No. __. ._ . ------------------ ---------- ---------- (Complete in Duplicafe) --- -" -- -------------------- ------- 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. JOB ADDRESS AND LOCATION.__.."*?/ "Wo—V-0-19 Gt. " ---------------------•-•-------------------------------------------•------------ --------------------------------•------- - Owner's Name------ ---------------•-�-�t� ---'-------Address - - ------------ - ------ Phone ---------------------------------------------•----------- - ----- -------- ------------ Contractor's Name______________�___•___�-� Installation will serve: Residence V Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms ._,�__ Number of baths f Lot size Ct ` l h r D Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table _.__--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: {If yes,date--------------------I No X New Construction: Yes ❑ No ❑ 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_.¢-_� Material----. l��wk�_ Ex No. of compartments ' -"Size-------rk-KA'.A7Liquid depth---- '�--------- -------- Capacity---O Disposal Field: Distance from nearest weff-----------------D•rstance from foundation---- Q. .-""-Distance to nearest lot line__- ,""" Number of lines------------1-------------- Length of each line--------- r�- ' --------- -Width of trench..__"", ' -___ �F ------------- Type of filter material-_____-- _ Depth of filter material------- ".___..Total length------------- Cl-'_--- Seepage Pit: Distance to nearest well-------------- fro fo ndation___,�( I istance to nearest lot line__."S_ -" r Number of pits_-.._____--/_._.Lining material___ , W - .Size: Diameter- - ---- Depth--- -------- Cesspool: Distance from nearest well_______________ Distance from foundation---_---------------.Lining material_..------.______-__"._____. ---- ❑ Size: Diameter---- --------- --- ----- ---- --Depth------- --------- ---------- ---- ---- - ------Liquid Capacity-------------------------------------- --------------------- -------- ---------gals. Privy: Distance from nearest well.._._..____._.__----____.._ ____ -- --Distance from nearest buildin 4 ❑ 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 County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------------------- ------------------------------- c� -- ------------------------ ---------------------- -----------------------------------------(Owner and/or Contractor) By: showing si `��J 4� -- --- ------------ -----------------------------------------(Title)-------------- -------- -.................... (Plot plan, showing size of lot, locatio of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..... DATE-- ---------- ------------- --------------------------------------- --- REVIEWED BY--------------------------------- --------------------- DATE._ BUILDING PERMIT ISSUED---"---------- ----------"----------•------------ - ----- --- - DATE Alterations and/or recommendations:_------/-. G --- ----- --•-----•--------------------------------- ------------------- li.... %�� .-- - t - ------- - ------- -- - --------- - --------- --- ------- ------------ --------------- _ FINAL INSPECTION -- � u - Date 1 ��5 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.