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rvrc vrrlt-t UJt: _ ------------ J X", ------- --- ----#_ APPLICATION FOR SANITATION PERMIT Permit;No. ------------ --------------------- ------ ------- (Complete in Duplicate) ------------------- ---------- - -- This Permit Expires i Year From Date Issued Date Issued V lr 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----------- Owner's Name------�r -C _--• ----------- Phone.Z a,.._3 '7 ------------------------------------------------------ Address---------- -..y -� ---•------------ --------. ----------- -----•-----------•--•--- Con#ractor's Name_____________ ____ ___ ---, Z/ d y�'L 7 ----- -- --------------------- -------- Phone.--Z/.d will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court • ❑ Motel ElOth �] Number of living units: ( Number of bedrooms _-J_._ Number of baths _f Lot size ____.-_Iy__y_-X ---------------------- Water Supply: Public system [7'Community system.❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand-0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe L Hardpan [] Previous Application Made: (If yes,date__________________) No 9+ New Construction: Yes ❑ No 93- FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publia sewer is available within 200 feet.) Septic Tank: Distance from nearest well----------------- Distance from foundation-------------------- Material Na. of compartments--------------- ---------- ---------------------Liquid depth---------- --------------- Capacity ------- - Disposal Field: Distance from nearest well__/Vq __,:-Distance from foundation--_.l-e .-_--- Distance to nearest lot line-SYf__----..• Number of lines--------------- -•, _~ Length of each line_-----�_a_ -------- - -Width of trench _-- -_�-- -_ Hype of filter material /1-" Depth of filter material-----L_e r,---__-_Total length_-_-- `- Seepage Pit: Distance to nearest Distance from foundation_--_-________---__.Distance to nearest lot line______ 4 ❑ lumber of pits------------------ Lining material----------- �.. , ----------Size: Diameter- - ------------ -- ----Depth---------------------------- Cesspool: Distance f3•om nears t`well .,�-_---_-.-.__Distance from foundation_____________ s Lining material ----------------------- --- �? ❑ ; Size: Diameter--------------------- --• - ---- -,�,.,�ueph�----- -----------------•--- Liqu;d Capacity---------------------------gals. Privy: Distance from nearest well__.-_____ ------------------------ - -------------------- ----- - ------•__--_�� - "`_r building ❑ Distance to nearest lot line, -_-_____ _ �s an � nearest bwld ------------------------------ Remodeling and/or repairing (describe)__________________________ �..� ' ---------------------------------- ----------------•---------------------------------------- ---------- -------------------------- ---------------------------- . -------------•------------------------------- ;'• - — — ------- --------- --------------------------------------------------------------- I hereby certify that I have prepared this application and that the woA will be done in accorddnce with San Joaquin''County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. 1 T- (Signed) '�� ------------ = --------- �1/` # ------- -- -----(Owner and/or Contractor) Title)--------- ----------------- ----------------------- --- ------------- ---------------- Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----__-_--_-4�p_i' _ REVIEWED BY - - -------•---------------------------------------------- DATE-- '�- ----------------------------------- �� ------ - ----------` _ _-_---____ - f f BUILDING PERMIT ISSUED - ---------------------- -- -------------------------------------------- DATE------------------------------------------------------ ---- i Alterations and/or recommends}lOns: l� �(_ ----------- -`-- �z. Ij 1 ----- --------------------- - ---------------------------------------------------------------------------------- ----------------------------- ----------------------------------------------- ----------------------------------------- FINAL" INSPECTIONBY:_._=._. - ..- ------ ------ 'Date- SAN afie SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California 1 Tracy, California F.P.CO.