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3 � / Irl l -- - --------------_��_. APPLICATION FZ SANITATION PERMIT Permit No. -----------. (Complete in Duplicate) Date Issuedil / }� ............................................. 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 o. 549. i �j/�, .r JOB ADDRESS AND LfCA N__ v_V .__._ - -- ------------ Owner's Name ------- ----- Phone 7I,>---71 Address--------------------- --------••--- -- - la t 4 P,L Contractor's Name--------••------------------- -------- --- :----------------•--- Phone. .. . Installation will serve: Residence W Apartment House ❑ Commercial ❑ Trailer Court [❑ Motel p Other ❑ -- Number of living units: __.)____ Number of bedrooms --'Z/Number of baths J--_- Lot size --_ 7 ------ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table &.Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑- Clay Loam [] Clay ❑ Adobe I( Hardpan Previous Application Made: (If yes,date-..-__.-___-_-_..._) No'$—. New Construction: Yes ❑ No 0— FHA/VA: Yes ❑ No CK -;y 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--------------------------------------------- ❑9kLS No. of compartments----- - ---- ------ Size--------------------------------Liquid depth--------- ----------------Capacit -------------------- Disposal ---------------- - Disposal Field: Distance from nearest well_-_-6O-Distance from foundation-_—0-..__---.-.Distance to nearest lot line_--Z Number of lines--- _[_/_ -------Length of,;each line._'___ _._ t Width of trench-----Z44-�(--- ------------- Type of filter material- - - Ok--Depth of filter material____-{ Total length---.--W----_-_---__.-___-__-_--_-- Seepage Pit: Distance to nearest well---------------------- from foundation -----------------Distance to nearest lot line----------------- C ❑ Number of pits----------------------Lining material-----------------------Size: Diameter----------.------------Depth.__ .------.-------.W :r Cesspool• Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- ` N Size: Diameter--------- - Depth---- --------------------------------------------Liquid Capacity gals. : Privy: Distance from nearest well-------_-----___________s____._.----_- ----------Distance from nearest building-----__----_____.____.___-__.___,R_._...;�y ❑ Distance to nearest lot Iine--------------------------------------------------------------------------------------------------------------------- Remodeling --.-_-_-_-_-_-.-_----- --------------------------------------- Remodeling and or repairing (describe): ------------ ------------ --- ----- ----------------------•------------------------------------------------- -------- N '• i -----•------------------------------------------------------------•---- ----------------------------- - ------------ .. ----- ---------------- ------------- ---------------------------------------------------------•--------------------------------------------------------------------------------------------------------------- --------- -- - I here6y certify that I hay pared this ap I' ation-and that the work will be done in accordance with San Joaquin-County r E ordinances, State laws, and r es nd rec�ulatio of the San Jo in Local Health District. (Signed)------------------------------ - --------------------- --- - ------- -- - - -- --- --------------------------------------------------- ---(Owner and/or Contractor) ----- Title---- ................ -------------- (Plot -----(Plot plan, showing size of lot. I ation of system n relation to wells, buildings, etc., can be pla d on reverse side). wfi FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _ --- '--------------------------------------------------------------------------------------- DATE------^'7 .4f•--------------- REVIEWEDBY--------------------------------------- ----- -------- --- ------- ----------- - -------------------------------------------- DATE BUILDINGPERMIT ISSUED-------------- ------------------ ------------------------------------------------------------------- DATE---------------------------- ------------------- Alterations and/or recommendations:_�...............__-._._.__.____ - ---------- --- - - - - . -� = ---------------------------------------------------- --------------------------------------------- { -------•----------------------------------------- --------------------------------------- ------- -- ---------------------- ' y- r• FINAL INSPECTION BY:----------_t�-_9_'-_---_--------------- • �-?— GJ Date - -- ------------- ------------------------------------ € 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 r F.P.CC. � l