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- { -� ��"_. APPLICATION FOR SANITATION PERMIT Permit No. ------------ (Complete in Duplicate) -------------- This Permit Ex ires 1 Year From Date Issued Date Issued ----f �- �� Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herei This application is made in compliance with County Ordinance No. 549. n described. JOB ADDRESS ANDC,j�ION----___--_,< �E Owner's Name---------- ---------, ,� • _ ------------------------------------------------ Contractor's Name ---•••----••-•--- ----------------------------------------------------- ---------------------------- -------- - ---------.. Phone----••--•---•-----.�.----- - Installation will serve: ResidenceApartment House ❑ Commercial • ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _._.�. Number of bedrooms __Number of baths ----'Lot size __�-Q �f Wafer Supply: Public s'stem -------- ----`------- y ❑ Community system ❑ Private ❑ Depth to Water Table �C3ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sand i_Loam ❑ Clay Loam ❑ Clay ❑ Adobe ]/�ardpan ❑ Previous Application Made: (If yes date.......... . .......) No New Construction: Yes [�p❑ FHA/VA: Yes ElNom- "' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) PZgwea Septic nk: Distance from nearest well-_r-_----_----Distance from foundation--/--Z� / . ---------.Materi�l.-- No, of com artments__- _ ,,.�/ c p .ti�'.------- size-_?/..-�z-- - •- Liquid depth- ''y ._ Capacity-- Disposal ---- Disposal ield: Distance from nearest well ---------- Number from foundation___ .._C�._�._.pistan to nearest lot lint;`__'... Number of lines--------- ---------------- Length of each line--------- --�---- _---Width of trench------ i- -------------- Type of filter material-_--� �- �� of filter materiallength --- L �-------- ..-Depthr Total -----------,ll'r1- --------------- Seepag Pit: Distance to nearest well.--_77= --_Distance frgm foundation--- 2} / -_-..Distance to nearest lot lme_ --__ ___ Number of pits_____ ___________---Lining material__ -4�- _Size: Diameter. ,. 1-3- ---------- Cesspool: Distance from nearest well---------------- Distance from foundation-. ------.Lining material----------------------------- ------ ❑ Size: Diameter------ --------------------- ---------Depth-------------- ----------- ---------- -------------- ---- ---- --Liquid Capacity-- --------------- -------9als. Privy: Distance from nearest well----------------- Distance from nearest buildin ------------------------ LA g -------- 0 Distance to nearest lot line ---------------- -------------------------------------------- ----------------------------------------- Remodeling and/or repairing (describe)______________ ------------------------ ------------------------------------ ---------•----------------------------•-------------------------------------------------•------------------------------------------------------------ ---------- ------ I hereby certify�th t I have pre ared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, dnd rules an regulations of the San Joaquin Local Health District. Si ned ( 9 } ry--�-- ----- ------------ -------------------(Owner and/or Contractor ----------------------------------------------------- (Plot plan, showing size f t, location of system in reiffi6n to wells, buildings, etc., can be placed on reverse side).e) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.._' ` REVIEWED BY---------------------- - -- ------ --------------- -------- --------- - -------- ---------------------------------------------- ------------------ DATE------------------------------------•------ ............... BUILDING PERMIT ISSUED_____________________ ._.-- --------------- ------------------ ------ DATE.--- Alterations and/or recommendations:___ �' = --- _-� �1' ------------------------------- --------------------------------= ------------------------------------------------------------- - -- -- ---------------------------------------------------- FINAL INSPECTION B - Date--- lS --------------- ._. •� 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.P.r.O.