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[-UK UH-ICt USE: -- ______________ APPLICATION FOR SANITATION PERMIT Permit No. v�= ------------------ -------------------------------------- (Complete in..Duplicate) This Permit Ex ires 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. r JOS ADDRESS A LOCATI N.. -_ 7�Y f - �f Owner's Name Address-------- > , �-- - `--------•----- -•--------------- = ------------------�----j---�-------/------------•- -- Contractor's Name_-- -- --- /------------------------------------------------------- Phone_4f�(u _7-E 77._ Installation will serve. Residence ® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other. ❑ Number of living units: _.1____ Number of bedrooms __a__ Number of baths _1___ Lot size _.i1-------------- I Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table jo ft. Character of soil to a depth of 3 feet: and Gravel Sand Loam Cla Loam Previous Application Made: (If yes,d: .&y' ❑ Y ❑ y ❑ Clay ❑ Adobe ❑ Hardpan ❑ -- ----------- ) No ($ New Construction: Yes No FHANA: Yes ❑ No ❑ IN INSTALLATION 1AND-,-,SPECIFICATIONS: �-,,,-;:m�,��-- '.' (No Septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from-nearest well_________________Distance from foundation__:___________---...Material i ❑ t No. of compartments------ ------- - Size--- ----------- -----Liquid depth------------------------- Capacity...................... W T E I� .. Disposal Field: Distance from nearest welli_"_. o----._ istance from found iipn___.,��'._______-Distance to nearest lot line----- Number of lines--------I------------------ --Length of each line =�-_.Width of trench- `R- �✓------- Type of filter material__1?4 -------Depth of filter:material-----/9?---------Total length___--- -_-----�-_ Seepage Pit: Distance to nearest well-------_------------___Distance from foundation-------------------.Distance to nearest lot line-----------._____ v ❑ Number of pits-------------- - -----Lining material--------.--------------Size: Diameter-- -------------------- Depth---------- ---------------------- cesspool-. ---------------Cesspool: Distance from nearest well-----------:.__-_Distance from foundation___._.--------------Lining material____-___________________________ - ❑ Size: Diameter------ ------------ ------ ------Depth- ---- ------------------ Liquid Capacity gals. Privy: Distance from nearest well___N____________________________.______________.Distance from nearest building ElDistance to nearest lot line.-..............____________ Remodeling and/or repairing (describe):----------------------- T ----------------- •------------------------------�----------------- ----- - -------------------------------------------- ------------------ t ----------------------- -------------------------=-----------------------------------------•-------------------•---------------------------------------------- # I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the Sart Joaquin Local-Health.District. (Signed)-- -=�- ��..... _• - - ------ _------ -- --------- ---•-_ - (Owner and/or Contractor By:----- e . . .. _-------------- --- -- ] (Title) . t(Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i f ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED By---- _._.[_T.R ��---____---------- DATE . -.� REVIEWEDBY------------------------------------- ------------ --------------------------------------------- ---------------------- --- DATE i BUILDING PERMIT ISSUED--------------------- --------------------C-------- ------------------------------------- DATE------------ -e ------------ ------------ Alterations and/or recommendations:--------------- -- ----------II-nr�-------.ILts.Tpe14D---.----QF------��----------49,-f'� ----- ------------------------ ---------------------- -- ----------------- [ ------- -- ----------- ----k ---- ----- -- - --------------- ------------- ------- --- ---- -------------- ------------- ------------------- - ---- •--- . 7 FINAL INSPEC - - - - - ----- bate------------- ._ � / -------------------------------- SAN - 1 F SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Flaaelton Ave. 300 West Oak Street 124 Sycamore Street 205 west 9th Street Stockton,California Lodi, California Manteca,California Tracy,California t