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FOROFFICE USE: ------ -----------j-0-,-alo ----- APPLICATION FOR SANITATION PERMIT Permit No. _42-..42ZaL . ------- -- ---I-- ------- ------------------------------- (Complete in Duplicate) Date Issued ---------------------_-------__---_--------___-------_____ This Permit Ex ices 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 4p. 549. JOB ADDRESS AND LOCATION--- Owner's Name------� ----------. Phone-------------------------•--------- Address.........._. ----------------------------------------------------------------------------------------------------------------------------------------------------- Contrac:tor's Name----- ----------------------------------------------- ---------------------------------------------- -------------------------------------------------- Phone----------------------------------- Installation will serve: Residence [sem Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J---- Number of bedrooms __ _ Number of baths /------ Lot size ----------- ----------------------------------- Water Public system ❑ Community system ❑ Private ❑ Depth to Water Table AD ft. 5 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [ Hardpan ❑ Previous Application Made: (If yes,date........ ..........) No I' New Construction: Yes ❑ No V— FHA/VA: Yes ❑ No [!t- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi I nk• Distance from nearest well-----------------Distance from foundation--------------------Material..........------------.--_-_--.------------._--. t No. of compartments--- - --------------------Size-------------------------------Liquid depth------------------------Capacity----------------------- Dispos ielDistance from nearest well-----------------Distance from foundation-----_------------Distance to nearest lot line----------------- :�C, Number of lines-----------------------------------Length of each line------------------------------Width of trench---__-_-------------_-____--_------ Type of filter material-----------------------_Depth of filter material------------- ---------Total length_.------.------__-----_-__----.----_-_---- Seepage Pit: Distance to nearest well__._`"-____..._._Distanc om foundation_r�_----____.---iisstaAnce to nearest lot line-�___.___._ Number of pits.--------- ---_- Lining material--_074!Q..�------Size: Diameter.-.__--_-------------Depth-----;Z S'-------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material......-.---.--.-----------------.._--. ❑ Size: Diameter--------------------- ----------------De th---------------------- ---------------__ - -Liquid Capacity gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- r ❑ Distance to nearest lot line---------- -------------------------------- ---------- ------------------------------------------------------ Remodelingand/or repairing (describe�:--------------------------------------------------------------------------------------------------------------------------------------- ------ W -------------------------------•------------------------------•-------------------------------------------•---•------------------------- --------------------------------------------------------------------- . ----------------------------------------------------------------------------------•----------------------------------------------------------------- ------------------------------------------------------------------------- N --------------- --- ----------------------------------------------------------------------------------------------------------------------------------------------- --------- ------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stadrulegulations of the San Joaquin Local Health District. (Signed) - ----------------------------- --------------- ----------------------------------------------------------------(Owner and/or Contractor) By:_---------------------------------------------------------------------- ---------------------------------------------------------(Title)------------------------------- --------- .... ---- -- ----- (Plot plain, 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------------- �i ------- -----------------•----------- ---------------------------------------- DATE---------- - -------------------------- REVIEWEDBY------------------------- ---------------- -- ----- -------------- ----------------------------------------------------------- DATE BUILDING PERMIT ISSUED------------------------------------ ----- DATE �j�� ---- --------- ------ ---- Alterations and/or recommendations:.-_-_-%-64- .y-.42�4�Q___._- -��V 2'y�k__-.hB .__L �l,�.r. c�: 1 i_. --_ -�1& ---------- -- --------------------------------------------------- -------- - ----------------------------------------------------------- ------------------------------- --------- ---•--------------------------------------- ---------------------------- - ------ --------------------------------- --------------------------------------------------- - I--------- -- --------------------------------------- ------------ -------- FINAL INSPECTION BY --------- �-- - ---_---__-`-- _ Date--. -- -- --- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California / FIRCC.