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FOR OFFICE USE: _ ___________________ __ °_.__ APPLICATION FOR SANITATION PERMIT PerrNt`Nio.', .. .-? ------------------------- -----------$ U--- (Complete in Duplicate) ----1-i .'-- .-.--- This Permit Expires 1 Year From Date Issued 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 No. 549. JOB ADDRESS AND- LOCATION------------ Z--- .- -_ -�- 1 �-- -- ----- --- '•---•--------------------- - ----------------------------- ---------- Phone----------------------------------- ----------------------------------------- Owner's Name Address----------- ---- -- --- r --•--•------------ - ---------•--------------------------•-------------------•--------------------------- Contractor's Name--------- --"- --------------------------------------- --------------------------------------------- Phone._------------------------------- Installation will serve: Residence Apartment House ❑ ' Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r � Number of living units: _._ Number of bedrooms.,.___- Number of baths _`0-- Lot size APAO .............. ---------------------- Water Supply: Public system 9<Community system ❑ Private ❑ Depth to Water Table 0-%7 f+ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: Ilf yes,date-----------.--------} No @�" New Construction: Yes ❑ No PErFHA/VA: Yes ❑ No+ TYPE OF INSTALLATION AND SPECIFICATIONS: s" (No septic tank or ceispool permitted if public sewer'is available within 200 feet.) Septic Tank: Distancelfrom nearest well-----------------Distance from foundation--------------------Material-------_.__-------------------------------------- ❑ "No. of compartments------------------------ Size--------------------------------Liquid depth--------------------------Capacity----------------.------ Disposal Field: Distance from nearest well-__"- --Distance fromI€oundation--e"047-_ :..Distance to nearest lot line______.___. �~ Number of lines------ /----__f__.. ------- Length of each line____©_..._ �� Width of trench.._�-_..f---_________________._ Type of filter material/- Depth of fii material---=/�____._--.Total length__.__' �' _.__._._.__________________ � i Seepage Pit: Distance to nearest well-__-*"-P'_____ Dista6n : fr m dation__/ .._.__.Dist nce to nearest lot line__.__ Number of pits.---.c _.------.__Lining materi �� -- -"_..size: Diameter_ "-__----_-DepthAo �14 ��-- Cesspool: ) Distance from nearest well-----------------Dista m foundation_-------------------Lining material-------------------------------------El N Size: Diameter-------------------------------------Depth--------- ------------------------- --------------.Liquid Capacity-...------------------------gals. 1 Privy: Distance from nearest well---. ---------------------------------Distance from nearest building._-._._..__------.______---_-._.____.__._. ❑ a`, Distance to nearest lot line.- ld � Remodeling and/or repairing (describe)------------------r. - --------- ---A � - ------ -- ' --------------- ---- -----0-------------------------------------- --------------------------------Ir ------------------------ I hereby ertify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances:, State Uws, and rules and regulations of fhe an Joaquin Local Health District. {Signed} �;£ �f ----------------------------------------(�/or Contractor) a - Title . BY: ( } 0 �• ----------- -- - --- -- ------ (Plot plan, showing size of lot, location of system in rel i to wells, buildings, etc., can be l paced on reverse side). L FOR DEPARTMENT USE ONLY 3 ,g APPLICATION ACCEPTED BY --------------------------------------------------------------------- ------------ DATE----- REVIEWEDBY----- --------------------------------------- ----------------------------------------- ---- --------------------------------- DATE BUILDINGPERMIT ISSUED-----------------------------------------=------------------------------------------------------------ DATE AIt rations and/or recomm_en ations:---;--- _______ _----------------------------..------____ _ ----------------------------------- ._d, - ---- --------------- ----- _ `-� �' •zfr Cir_ '" _ FINAL INSPECTION BY------------- �- ---------------------------------- --- Date--------fi'` `r........ ` ---------- ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1 , 1801 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.O O.