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FOR OFFICE USE: 7 ---------- --aa,------ .,.. -.• ----_..--.. APPLICATION FOR SANITATION PERMIT Permit ------ (Complete in Duplicate) .S� __ __________ __ ___ This Permit Expires 1 Year From Date Issued Date Issued ______ ___t+__ 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-----------(�-.-�-`_5= �±5��, --------------- ------------------------------------------------------------------------ ------------------------------------------------------------------------ Owner's Name------------ P,,k_ -----•---- ... Phone__ Address. -�`p ------------------------------------------------------------------------...---------------------------------•- � -- £�. kit Contractor's Name = --------------------•-------------- ... �`. _ Phone..--• Installation will serve: Residence ❑ Apartment House ©- dom I ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units: ____ Number of bedrooms 2___ Number of baths A-_- Lot size ----- ----------------------� Water Supply: Public system [9-160mmunity system ❑ Private ❑ Depth to Water Table -------- ft. t Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeHardpan ❑-s%k Previous Application Made: (If yes,date..:.........._..__.) No ElNew Construction: Yes 2—N ElFHA/VA: Yes ❑ No ❑`_� TYPE OF INSTALLATION AND SPECIFICATIONS: V (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........ ------------ - -----------Liquid depth--------- .---------Capacity-_-- Disposal Field: Distance from nearest .......Distance Distance from foundation---, / `__._...Distance to nearest lot g Q� Number of lines-_______mss.......______--_-_.---Length of each line--------- -.--------- Width of trench--------g°__ �_'-'_._ i Type of filter material.- —a r Depth of filter material-___-! 'r-_____.Total length----------19 --------.------------ Seepage __-_Seepage Pit: Distance to nearest well----- ------------Distance from foundation__/_-?_V_r____.Distance to nearest lot line---S ----------- Number of pits--------_ -__ �,�= ______Lining material_ aSize: Diameter-__ -fP _ ....._Dept�_. ----------------------- 1 Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material--------------------- _._:_-- 6... �:. ------ 0 17-71 '--------------------------------- Li uid Capacity------------- -- -----gals. } Privy: Distance from nearest well------ -------------------------- --------------Distance from nearest building----.-.------------. ❑ Distance to nearest lot line---------------;--------------------------------------------------•--- - I Remodeling and/or repairing (describe):____...`-- _A___: ter -----------------------------------------------------------•---------------•--------•----------------------------•-------------------------------•--- --------------------------•----------------------------------- ----- ------------------- ------ ----------------------------------------------------------------------•-------------------------------------------------------------------------•--------------------------------- ------ 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 regul tions f the San Joaquin Local Health District. �____.Jt.F__. Owner and/or Contractor (Signed) ------------------------------------------------- -------------- ------------- { ) By--------------------------------------------------------------------------------------------------------------------------------------(Title)----------------------------- ---------------------------------- (Plot plan, 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 ` , -- - �— ------------ REVIEWEDBY------ --------------- -- --- -------- - - ---- --------------- ----------------------- ----- --------------------------- DATE----- --------------•---------- BUiLDING PERMIT ISSUED------- ------ -'Si ------- DATE------------------------ ------------------------------- Alterations and/or recommendation0.s- - - -- -------- y`- � -------------- ------ ----------------------- -- ----------------- { ------------------- --------------- --------- -- -------- -------------------------- ------------------ -------`----------------------------------------------------------•---------------------- --------------------------------- ------------- --------------- ------ ------ --------------- ---------- ------------------•-------------- --------------------------------- -•---- -------------------- --------------------------------------- FINAL ---------- --------------------------- FINAL INSPECTION BY:........ .... .. . .,� - ------.----_-------- Date-------. -- `�� -- - - - ----- -------- ---------------------------- AN AQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocklon,California Lodi,California+"P�K.'- Manteca,California Tracy,California --- �� F.P.ca. r��