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3 -7----------------- - -------------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ---------•----- --------- ------------- ------------- (Complete in Duplicate) --------------- -- ------ --- ----- --- �----------- This Permit Ex fres 1 Year From Date Issued Date issued H 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 LOCA N ,�._ T rs --------------- Owner's Name_-------- l -r �--•-----:-----�4��-�t_"�.---------- --- ----=----- �---------- --�----------- - -- --•------. Phone.--•-------------=----- - �'j - --------- Address . ......... ----- -- ontractor's Name__________________-__- I �. --. ---= -..... Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms S--- Number of baths I___ Lot size -___. 6 /�--------------------------- Water Supply: Public system P( Community system ❑ Private ❑ Depth to Water Table _C2 ft. Character of soil to a depth of 3 feef. Sand ❑ Gravel (] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adob� Hardpan ❑ - Previous Application Made: (If yes,date t S--'-..--) No ❑ New Construction: YesK No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECT (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi Tank: Distance from nearest _ .. - Distance foundation !---------o. o compartments_-_____l- Size_a 't �GLiquide h - hCapacity- Disposal y f Field: Distance from nearest well--- 1�.-.Distance from foundation_-_f(j:-_��-----Distance to nearest-lot line-__�____.._._ Number of lines-----_-----3-------- ----------------Length of each line--__-_/ -{}-- -----------.Width of french......_.?',V-`e----- --------- }� r Type of filter material_ e-i_/Poc(tDepth of filter materiaC-______ _. _ `' _To '— Y tat len - � ---- 9th------��"-----•------------------- Seepage Pit: Distance to nearest well----------- -----------Distance from foundation------------------- Distance to nearest lot line_._______.____-_ ❑ Number of pits--- -----------------Lining material------ --------------- Size: Diameter---------------------- Depth------ ---------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- ❑ Size::Diameter ---------- -----------------------Depfh----- ----------------------- ------------Liquid Capacity--------------------- ----gals.. Privy: Distance from nearest well ___....---- _---------------------------------_Distance from nearest building----------------------------------------- El Distance to nearest lot line-------------------------------------------------------------- 4-- Remodeling and/or repairing (describe)------------------------- -------------------- ; , -----------•--------------------------------------•------ ---------- -------------------•--- ------------------------------------------ - - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 1 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)___-- _ --------------------------------------------------------(Owner and/or Contractor) By: ------------------- ------------ ------------------------- - ------ -----------(Title)------------------- ------------ ------- -- ------- - ---------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- DATh_______ - ------------ � ------------------ EVIEWED BY - - ------------ ------------------------------------------------------------------------- DATE - ------------------------------ BUILDING PERMIT ISSUED---------•---------------------------------------------------------- ---------------- ------------- DATEAlterations and/or r Commendtions:.__----------------------- __________._..___ �ltE � 4� ' l / i s- j" h;K------- 14(1--------- r ------�A67----j� k ,/� ----------I----------------------- ---------------------------------------------- - FINAL INSPECTION = bate SAN AQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy, California