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FOR OFFICE USE: ...._ei--_.___ = '--- APPLICATION FOR SANITATION PERMIT Permit No. . --------------------------------------------------------- (Complete in Duplicate) ---------------- _ _._ This Permit Expires 1 Year From Date Issued Date issued ___l_��_= � 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 LOCAT N---p7�Z --- - •J _. x.51. -----------= ------- --------------------------------------- Owner's Name-------------- eS.-- ` / /V-- .��----------------------------- Phone------------------------------•-•--- Address----- -------_- 1/ 9--------- e--------�- -- .-��'- ---------------------------------- Contractor's Name - � s Phone.. Installation will serve: Residence 5f\partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __%._. Number of bedrooms _.y Number of baths ___l__ Lot size ------- --------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [_1 Clay Loam [RO"Clay [] Adobe [] Hardpan ❑ Previous Application Made: (If yes,date------------- __..) No New Construction: Yes ❑ No [?' FHA/VA: Yes ❑ No E�3-- 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_____-._--_____ 0 Number of lines-----------------------------------Length of each line-_--------------------.------ Width of trench----------------------------------- Type of filter material ----------Depth of filter material-----------------------Total length_-_.-------------------------------------- Seepage ___..____________________.______-___. See a e Pit: Distance to nearest well______ _. _ _ Distance fr foundation �__-f ,p—,g . _ ____ ._.___.D�stance to nearest lot line__._- Number of pits__.________________Lining material--S -�e_lC__.Size: Diameter.._.-�v__-__. Depth_._ r __�____.___.._ 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__-._...__________________-________- a ❑ Distance to nearest lot line------- 4 Remodeling and/or repairing (describe}:__.._f_F ___ ___._____ k1_ _____________________ - - - ---------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 1 hereby certify that 1 have prepared this application and that the work wi a done in accordance with San Joaquin County ordinances, State laws, and rules nd re a sof the San Joaquin Local alth District. (Signed) ---- ----- ------ -- --- � 5- - '-G._- wn and/or Contractor} B ------- - ---- [� � Title � � Y - -- ------------- (Plot plan, showing size of lot, location of stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- 6:5-Ac--Cf----------------------------------------------------------- DATE-------- 3— lAe----------- ----------------- REVIEWEDBY-------------------- ------------------ ---------------------------------------- ----------------- DATE----------------------------------- BUILDING PERMIT ISSUED--------------------------------- DAT !---- Alterations and/or recommendations: t ---------�---- 9r =----•------------------------------------------- --------- -------------------- ------------------------- ---------------------------- ------------------------------------------------------------------------------------------------------------------- ---- --------------- --------- ------------------------ . ........... . - FINAL INSPECTION BY:----- ------6 - -- --------- Date---- C:--..- ------ --- - ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.RCO.