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VUR(.A-MA: USE: ls= --- -----------------per _____________________/-d___-._. APPLICATION FOR SANITATION PERMIT Permit No. . / ------------------------ ---------------------- ------- - [Complete in Duplicate} ---------------- ---A. This Permit Expires ] 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 Ordinancfe� No. 549. ' JOB ADDRESS AND LOCATION.__Ll_r -- YQ/j,�,try,�.? - = Owner's Name "�� -• - ------ = --------•-----•-•-•-------•----•------------------------ ------------------------------ ---- Phone-----•----.------------------------- Address--------- Contractor's Name------------- ----------- ----- 1- --------•------------------------------------------:- Installation will serve: Residence A aartmef House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I____ Number of bedrooms Number of baths I_____ Lot size --------f __Q_-x---LA-_0----------------_.__ ; Water Supply: Public systems Community system ❑ Private ❑ Depth to Water Table G_b-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoamV Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [ Previous Application Made: (If yes,date_____---- _.._.__.) No New Construction: Yes ❑ No E] 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------------------- Material___.______.___.._.__._._._______-_____.________. ❑ No. of compartments-------------- -------- --Size------------------------- ----Liquid depth--------- - --------------Capacity----------------------- Disposal Field: Distance from nearest well------- ------Distance from foundation-------------------.Distance to nearest lot line____._________-- ❑ Number of lines-----------------------------------Length of each line_-----------------------------Width oftrench----------------•------------------« Type of filter material---------------___ _...Depth of filter material-._______.____-_--___Total length-------,-_----_____.___________________-- Seepage Pit: Distance to nearest well_f_.0_Q_........Distance komf undation__1_Q___________ Dista �lre to nearest lot I line/5 ........... ^� Number of pits.---__1--------------Lining material__I_f-O-C,-K----Size. Diameter.-_c�-cit_-----------Depth_.1-15-_-------------------- Cesspool: Distance from nearest well_________________Distance from foundation-----------------_Lining material------------------------------------- EJ __________.__._____.______.__ _____❑ Size: Diameter-------------------------------------Depth---------------------------------------------------Liquid Capacity-_-----------------------gals. Privy: Distance from nearest well__________________.__________;_ _—---------Distance from nearest building-,._.___.______________--_-_--__.___._- ❑ Distance to nearest lot lire------------------ ------------------------------------------------------------------------------------------------------- ---------------- Remodeling and/or repairing (describe) ------------------------------------------------ -------------------------------------------•------------------ ---------------------- k - ---- --- -----------------------------------------------------•------------------- i - --------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, t to laws, and rules and regulations of the San Joaquin Local Health District. ---- (Signed)---�L4!d__A,6, --^^-•- C - E t - -.(Owner and/or Contractor ) Y ------•------------- ----------------------------------------------------- --------- ------ ......---- -- . --- (Plot plan, showing size of lot, location of,'sysfem in relafion.fo wells, buildings„etc.,.can be placed on reverse side). FOR DEPARTMENT USE ONLY / �f APPLICATION ACCEPTED BY-- ------ - ---- DATE--- (�__' �-f-__-/ REVIEWEDBY-------------------------------------------------- --------- ----------------------------------------------------------------- DATE i BUILDING PERMIT ISSUED-------------------/ . ----------•- --------- DATE.---- Alterations and/or recommendations:---(l/= _ _,?a�r�?�t+�_ 'J -- ------------- - -------------------------------------------------- _ -4-64 -------------------------------------- � ------ i_ � - EX -------------------- - -- - ------------------------------------------------------ it ---------------- --------------------------------------•- ------------------------------- -------------------------------------------------------------------------------------------- -------------------------------------- FINAL INSPECTION BY:---- ` - - Date....... , E SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124'Sycomore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r