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rust urricL U5E: " --------- ----------------•__--------------------•__"' APPLICATION FOR SANITATION PERMIT Permit No. ._ _ _,IY 4; - -,z (Complete in Duplicate) / - -- ----- ------- -------- ---- --- This Permit Expires i Year From Date Issued !- - I bate 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. -------------------- JOB ADDRESS AND LOCATION_"& ,�1 V ----- wner's Name---•- --------------- -- -------•-------------,-------- ---------- ------------------ --- ------- ----------- ------... Phone-------------------- - - ----------- - Address --- - ----------•------------------ Contractor's Name----------- ,p �" ---"----------------•- ,✓ �'" ��" - ------------------------ -------------- --- •--- Phone•.--------- - -�------------ Installation will serve: Residence p ❑ Trailer Cgfi-_" "- otel ❑ Apartment House ❑ Commercial �vrl ❑ Other ❑ Number of living units: --k Number of bedrooms ---/_ Number of baths -- Lot size Water Supply: Publics stem 1 PP Y y ❑ Community system ❑ Private Depth to Water Table _,Z9 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Cloy Loam ❑ Clay Adobe❑ Hardpan ❑ Previous ApplicationMade: (If yes,+dpte.____" l ) No M- New Construction: Yes V2- Vo ❑ FHA/VA: Yes ❑ No Fjj_ TYPE OF INSTALLATION AND SPECIFICATIONS: wc,(No.septic.fank or cesspool permitted if public sewer is available within 200.fee#.Jr, --- Septic Tank: Distance from nearest well---e_...__Distance " " Mater_ia".�, pp _ ----- ..... . ......." -_-",-__Liquid depth_"- _CapacityNo. of compartments- _ " eom foundation---49 Distance from foundation---19-1___-___-Distance to nearest lot line Disposal Field: Distance from nearest wellf rn Number of lines-_�.--_�____ - _____ . Length of each line____eP_"`______-_---.Width of trench-. 1 ,,� f , ----- --- V% Type of filter material__1jt Depth of filter material -/40_ -----Total length-----e"0----------------------------- Distance "__""" "" Seepage Pit: Distance to nearest well "__" ---------- - j Number p # _-.--_Distance from foundation--------------------Distance to nearest lot line---__---_.___-._ ❑ Number of its-A------------------Lining material----------------------.SizE: Diameter----------------"--- Depth---------- -------------------- Cesspool; Distance from nearest well-----------------Distance from foundation---------_----------Lining material_..""_- i - -- ❑ m Size: Diaeter----t- -------- Depth I --- ----- ------ ----- ------- Liquid Capacity -----------------------------j ------------------------- -------------- -----gals. Privy: Distance from nearest well__--------- ---------------------- ---- Distance from nearest buildin 8 ❑ Distance to nearest lot line------ ------------ ------•--------------------------- -- g - Remodeling and/or repairing (describe):------- ,.�ir� - f.___"" "". ----------- p & ------------ ------------------ --------------------- 9- ------- ---------------------------------- --------------------------------------------------- ----------------------------- -----------•--------- ---------------------------- --------------------------------------------------------------------------------------------------------------- ------------------ I hereby certify that I have prepared this application and that the work will be done in accordance wifh San Joaquin County ordinances, State laws, an rules andrrogulations of the San Joaquin Local Health District. (Signed)_------------- - G - ----------- ------- ---------- . BY=--r-------------------------------- •----• Title " Contractor) --- (Plo# plan, showing size of lot, location;of system in relati o wells, buildings, etc., can be placed on reverse side). FOROEPARTMENT USE ONLY APPLICATION ACCEPTED BY I_. Ci -- ---------- --- ---- ----- ---- DATE----------- - 40 REVIEWED BY------ ------------------------- - - ------ ----- -- ---- ------ ------- - DATE: BUILDING PERMIT ISSUED----------------- I - -----------------"--------- --------------------- --------- ----- - ----- DATE-------- Alterations and/or recommendations: --- -----_____-___-____- ------------- - --------------------------------------- ------------=- ---------------------------- ---- ------------- - - -- - --------- ---- ---------------------------- ------------------------ ---------------- ------------------------------------------------------------------------ -------- -------------------- ----------------- FINAL INSPECTION BY�_ -------------------- Dat Or i® SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street Stockton,California 205 West 9th Street Lodi,California .�s --� Manteca,California Tracy,California F.p.CO.