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FOR OFFICE USE: - ------ APPLICATION FOR SANITATION PERMIT Permit No. -Zi :S ........ - (Complete in Duplicate) Date Issued ------------ ---- ---- ------------ is This Permit Exi2ires 1 Year From 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��-- ---�--. -- --�------�--•-- ----- -- -- - -- --�- • -- Owner's Name .+ "' ------------------------------------- Phone. Address----L6'_..---i----- f ----------•--------------------------------------------------------------------------------------------•-------•------------------------ Contractor's Name---------- - ��-- •------ -------•----- -- Phone.. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1----- Number of bedrooms . .. Number of batik Lot size ------767_ --��---------------------- Water Supply: Piublic system El Community system [_PPrivate F1 Depth to Water Table -I-P._ tt. Character of soil :to a depth of 3 fee+: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 2---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� 0-F___�Distance from foundation-_44?-'r oundation__44'�________.Material___.r�� -- --------- p • ". No. of compartments Size �� ---?----Liquid depth Capacity Disposal Field: Distance from nearest welkX-P........Distance from foundation1_0_--_______-.Distance to nearest lot line_________________ Number of lines-----0-----------------------------Length of each line__/R_q------------------Width of trench._a--.- .----.----------- 4 - l� y -------------------- �l Type of filter matenal___.��G�.- ---Depth of filter material___/ '__ __________Total length_____-rb�?_�_-- - - n____________.__._.Distance to nearest lot line__._________---- Seepage Pit: Distance to nearest well ---------------- ___-Distance from foundatioQ ❑ Number of pits--------------- ----- Lining material------ -------------- -Size: Diameter- Depth . Cesspool: Distance from nearest well________________Distance from foundation__._- Lining material___._._____------ gals, ❑ Size: Diameter----- -------------------------------Depth--------------------------------- - ---------------.Liquid Capacity-- .------------------------9 Privy: " Distance from nearest wel!-------------------------------------------------Distance from nearest building-----------------------------------------. ❑ Distance to nearest lot line--------_-------- ----------- --- --------- - - ------------ Remodeling and/or repairing {describe ------------------------ -------- ---------------- -------------------------------- -------------------------------------------------------------------------------1-1. ------------ ---------------- --------------------------- ----------------------------------------------------------------------------------------------------------------------- ----------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin oun*111., ordinances, State laws, a r s and r ul ions o the San Joaquin Local Health District. ------------------------(Owner and/or Contractor) (Signed)------------------ a Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY...�--- ----- - - --------------------------------------------------------F----- DATE 9- REVIEWED BY--------------------------------------------- --------------------- ---------- -------------------------------------- ------ DATE------ ---------- ------------------------------------ BUILDINGPERMIT ISSUED------------- --------------------------- ----------------------------------------- DATE Alterations and/or recommendations:__________________________________ ------------------------------------------------------------ r ; id • Ce"6 FINAL INSPECTION BY: - - Date... ------`S`------------- -------------- -- --------------------------- I SAN JOAQUIN LOCAL HEALTH DISTRICT 601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.EO. - '