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APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) f -�- --- 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.-------- - _.w' �- �' T" •�.. 5 -------- ----------------------------•-------- Owner's Name---------- -------------- --.�U_.�'�,g-/L--------�-------G`�`�,✓<t!5-----,/� -------------- --- err. Phone----------------------•------------ Address------------------------•-------------•-------------��---�---- -U`-'-�--- --�aC.c�-l-``�'...5.--------•------------••----------------- ----------------------------------••---- Contractor's Name ------------------- - -5 -------z, - -•--- Phone. `�ffe "? Installation will serve: Residence [R'Apartment House ❑ Commercial Trailer Court ❑ ❑ Motel ❑ Other ❑ Number of living units: ---/___ Number of bedrooms _ -_ Number of baths ---/-_ Lot size ------c ._0__ -fao Water Supply:Supply: Public system li4Communify system ❑ Private ❑ Depth to Water Table -------- ft- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El---Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: [if yes,date--------------------) No E3---New Construction: Yes W?'�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- -- ®i �c52--- --.-.Material------ ,�.��/Ps,j-------------- No. of compartments- -----------Size_-- ------Liquid depth------ ------Capacity-- � 1 Disposal ield: Distance from nearest well----------- ----Distance from foundation-_1f---. ---.Distance to nearest lot line---� _ fJ-_--_- Number of lines------------ _ '�_�-- -- -__Length of each line----_-_ o / -------- -.Width of trench------ ��---+�- ---------- Type of filter material_-- � --Depth of filter material---Z—e-'_�_ - Total length i�` - ------- Seepage Pit: Distance to nearest well-------- --_---____Distance fro foundation--- ._ ___.Distance to nearest lot line-_---..---------- [� Number of pits__.--- ------------- Lining material--- _Size: Diameter.-.- Deptn ''1•` --- --- ----- J 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):-------------- ! _� e'r ------------ V:O �_'' /,'_/------•------------------ ------•------------------------------- -------------------------------------------- - ------------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------- ------ I hereby certify that I have prepared this applications and that the work will be done in accordance with San Joaquin County ordinances, State laws, andP"o, nd regulations of the San Joaquin Local Health District. (Signed)---------- ----- - �r� �� -- fix- ---------- ------------------------.-___.-.._-- wn nd/or Contractor) By:--------------------------- - �� (Title) (Plat plan, showing size of lot, ocation of syste relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY � � -------------------- REVIEWED BY----- --------------------------------------------- --- - ------------------------------------------._ – --- ------------- -------------- DATE BU) DING PERMIT ISSUED------------------------------------------------- � DATE-Alterations and/orm / ----------------------------- - y --------------------------- --- ----- -------------- ------1--------= 1 -------------------- -- --------------------------------------------- •----------------------------- ---------------------------------------- ------ FINAL INSPECTION BY:--- Date ------ ---- .�-- ------ ---- ----- ----------- 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.F.C Q.