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FOR OFFICE USE: ' .. ` --------------- - ---- .___. ----------- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ........- --------------------- ----- --------------- This Permit Expires t'Year.From Date Issued —Date Issued Application is hereby made to the-San"Joaquin Local Healfh-,Dist t for a.per to construct and install the work herein described. This application is'made in compliance with County Ordinance o.`549-_' r JOB ADDRESS AND LOC ON--- --- �. Owner's Name - ------------- ------- - -- •------------------- ------- ----------------------------------- Phone-------------- Address-----_------------_---- --------------- Contractor's Name----------•-------•--"_"- - ` ----"----••-------•---•------------ - ...-•------ Phone- - --- ---- -- - - -- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel r ❑ Other ❑ Number of living units: J.---- Number of bedrooms __- Number of baths _..�___ Lot size `S _.....x___,�"Sp ~ Water Supply: Public system Community system f { y y ❑ Prue [] Depth to Water Table ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel Sand Loam Clay Loam Clay❑� Y ❑ y ❑ y ❑ Adobe ' Hardpan ❑ Previous Application Made: (If yes,date--------- ---------.)�No New-Construction: Yes ❑ No;K FHA/VA: Yes ❑ NoK 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.-------- _-._--------------------------- I �ifCxS No. of corn artments-.1------i------- t - + - p , : . Size Liquid de to 'Capacity----------------------- t Disposal Field: Distance from nearestwell /S�Q./�`�istance from foundation__.._ g 7------- _.Width of trench_ lot line--------•---__-•• Q Qistance to nearest Number oflines. rC�_ �_�._--__"""-Length of each line.__- r� -----------------••- Type of filter.,material----r _1_.____.--.__Depth=of filter material___..__"= ____..___Tota( 'length_.t____.._-"---------------------------- Seepage __."" "• ------------------ �. Seepage Pit: Distance to"n'earestwelt'. -:'---_----.--__-_Distance from foundation--------------------Disi'ance to nearest lot line----------------- Number of Pits PILi1 g ❑ material---------- -------Size; Diameter-----------------------Deptn--)------------------------------ Cesspool: Distance from'nearest well__-°:_____._ Distance from foundation--------------------Lining material__.._.f_"---- -----------------. ❑ Size: Diame`ter_.__.. ___. r ` ------Depth-------- ------ ---- ----------------------Liquid Capacity----------------- gals. •.�. . • , - Privy:. Distance from nearest well:-_._-.t.-____.-__ ,__Distance from nearest buildin I _ �,. 9 = -------------=----------------------- -,x..R.,� I. { a Distance to nearest lot line_ _____._ "-`""--'-`"'-^---"�^-T+ Remodeling and/or repairing {descN IT):�.^=- '.a__ ----- t ------- --- ---- ------- --- - - ----------- �.._.. T •- - _==_._.� . c I Hereby certiffan ve prepar"ed this-applicatiori'arid fhat�he work will-be"�one in accordance wiffi San Joaquin County ordinances, State lles aqd reg ions of the Sa oaquin Local:Health Di rict. - (Signed) �`-6�--- - ---`- /� � --- -- -- ----- .---�------------------ --{Owner and/or Contractor) ' $Y= G�ti(�1 (Title)-- on plan. showing size of lot, location of system in relation wells, buildings, etc., can be pla an reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ---------- - - y --k'� ----- -------- -- DATE ----- ------------------ ------------------------------ REVIEWED E -- I IS - DATE----------------------•------------- ---------------------- ILDING PERMIT ISSUED --------- ------- - ---- DATE - ------------------------------------------------- - --------- ------------- Alterations and/or recommendations:_...._. _-r�- ---------- � `� --•{ - -------------------------------------- �. FINAL INSPECTION BY:.. Date ,/j/---`0� SAN-JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C Q.