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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ------ -- ---- -- ------- -- -------------------- (Complete in Duplicate) I ---------..____________________________------------- ___ This Permit Expires I Year From Date Issued Date Issued ___ , •-r Application is hereby made to the San Joaquin Local Health District for at permit to construct and install the work herein described. This application is made in compliance'with County Ordinance No. 549. JOB ADDRESS AND�L )CATIPN_______ ------------------------ Owner's Name _`° = ��7... '2� ; ---- Phone •-------- Address 1 t -------------------------•-----... Contractor's Name------------- y- C) - Phone----_--------------_---------- Installation will serve: Residence Apartment House ❑ Commercial 0 Trailer Court ❑ Motel ❑ Other ❑ r 96 Number of living units: __-/.. umber of bedrooms _Number of-baths_:__ Lot size _-- - ..._____________________ Water Supply: Public system [Community system ❑' Private ❑ Depth to Water Table6-0- ft. Character of soil to a depth of 3 feet:; Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0,/H- ardpan ❑ Previous Application Made: l if yes,date____________________} No New Construction: Yes ['No ❑ FHA/VA: Yes 0 No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 5 Septic T k: Distance from nearest well __---_--_Distance from.foundation_ --------------_ .Material- No. atefial_No. of compartments-----7Z-- --.__...____Si ----------Liquid depth__._-7 ------ Capacity... Disposa ield: Distance from nearg�t well____'______-____Distance from'foundation__ _ Distance to nearest lot Number of lines----F Ft /th of each line `�_/--- .-.Width of trench....__��._. __ _.______Depth of filter_mater al �~ __ C� jj { Type of filter material_-�-�� Distance from foundation `, -Total length___.___��_0_�_________________ See Pit: Distance to nearest well------- Distance to nearest lot line__. ..__..__ Number of pits----------------------Lining material-----------------------size: Di meter------.-----------____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 building____._____.______________________._._. ❑ Distance to nearest lot line---------------------"---------------- ------------------------------- -------------------- ---------------- --------------------------" 11 Remodeling and/or repairing (describe /}') ' e):-----------� ' 7 _.�•�--•--- , 1 ----------------------------------------------- ------------------------------------------------------------------ 1" --------------- ----------------------------------------------------------------- -------------------- ----- -----. - ------�-------------------•----- --------------------- ----------------------------------------------- -----------------------------------------------------------------7------------------------------------------------------------------------------------------------------------------•---------------------------- ! hereby certif at I have prep d this application and that the work will be done in accordance with San Joaquin County j ordinances, State aws, n rules a r ul ions of the San Joaquin Local Health District. (Signed)------------ - - _-- -- -.- .- __-- __-- ._-- ----------------------- -------(Owner and/or Contractor) I Plot plan, showing size of location - -- ------- Title .. ___ - ----------------------------- ( ) ' ---------------- --------- ( p g of system in relation toas, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- - -. _ --------------- -- ------------ DATE--?-=C}`�'- -��------------ - REVIEWEDBY-------------------------- - ---------- - ------------------------------------------------------------------- DATE------------------------------ --- - BUILDINGPERMIT ISSUED------------------------------------------- --------------------------------------------------------- DATE----------------------------- --------- -------.------- Alterations and/or recommendations------------------ ` _._- -- ----------------------------------------- ------------------------------------------------------------ ----------•- --------------------------------------- ------------------------------ i --------------------------------------------- --------------------------------- ---------------------- ----------------------------------------------------- ------------------------------------------------ ------------ ---------- -- . . ------- ------- ---------------------------- ------- --------------- --------------------------------------------------------------------------- F1NAL INSPECTION BY: Date.... ---------- _�5 I `SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak'Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California a Manteca,California Tracy,California F.F.00.