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FOR OFFICE USE: --.------------------------------------------------------- -7} g% .-:._.____-`.______-__--------------- --------------- APPLICATION FOR SANITATION PERMIT Permit No. -r�--`_�-a�...��../.. --------------------------------------------- ---- -- {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 work her in described. This application is made in complian a with County Ordinance No. 549. JOB ADDRESS AND OCATION..'.,_ -`,"� ------------------------------ , Owner's Name------- - _- ._ 5 - - _ � Z �� °til Phone Address f - :....� q 7 Contractor's Name_/.rl1 JE---.. --------.��--'hone--------•-------------------------- Installation will serve:" Residence Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I------ Number of bedrooms --?r-.- Number of baths -1----- Lot size -� ,---------------------------------------- Water Supply: Public system ❑ Community system ❑ Private IJ Depth to Water Table Job— ft. Character of soil to'a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [] Clay Loam a] Clay ❑ Adobe❑ Hardpan,M ` Previous Application Made: (If yes,date........_----------) No ❑ 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:7P�------Distance from foundation-_t --------Material--� C,?-- ------------ ------------ � 1� No. of compartments------ "------------- 5ize± ---' lltLiquid depth-----6o°._._.--- . Capacity-/�'a--_f-----X Disposal Field: Distance from nearest well-----------Distance from foundation----?-Q --------Distance to nearest lot line_ Number of lines ----� Length of each line____ _a � � ------------ ------- 9 �-------- ----------.Width of trench- y�-----.�----- ---------- Type of filter m feriao, --....____.___Depth of filter material--- - -._-._Total length--,/------------------__-._------.� I � Seepage Pit: Distance to nearest well-/�_�D..---------Distarice-fJro� foundation----!��!_------ Distance to nearest lot line.----__--_-.. Ai Number of pits_---------------_Lining material-fe4-..........Size: Diameter__-33.--- Depth--_ _.---.-------------. =- Cesspool: Distance from nearest well-------------_-_Distance from foundation-------------------.Lining material--------------------____-----_------. ❑ Size: Diameter--- ------------------------------:Depth----------------------------------------------------Liquid Capacity--------------- -- - -----gals. i Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- ElDistance to nearest lot line ----------------------- -- ----------------------------------------------------------- ------------------------------------------- Remodeling and/or repairing (describe)----------------------------------- ----------------------------------------------------- - -----------------------------------•--------------------- I. --------------•-- •------------------------------------------- ------------•------------------------------------------------------------------------------------------------------------------------------------------------- ----------- ---------------------------- 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 rules and regulations of +he San Joaquin Local Health District. {Signed} ------------------------------- (Owner and/or Contractor) g ' -----------------------------{Tit e} ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- VDATE-4-a` DATE- -.,t.-..6'�---------------------------------------- REVIEWEDBY-------------------------- -------- '------------------------ -- ------------- -----------------------------------------.--- DATE--------------------------- ------------------------------ BUILDINGPERMIT ISSUED------------------------------- ------ --------------------------------------------- ---------------- DATE-------- ------------------------------------------------ -- Alterations and/or recommendations---------------------------------------- -- - -----------------------------------------------------------------•---•- ------------------------------------------ ------------ ---------------------------------------------------------------------------=--------------- ------------ ---------------------------- -------------------------------------------------------- �- t FINAL INSPECTION BY: ' -------------- ------- Date------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California