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rvrc Urt-K-L USE;; ----- -------- - ----------- -- ---- ----- -------------------- APPLICATION FOR SANITATION PERMIT Permit No. - -------------------------------------------------------- (Complete in Duplicate) -- ----'------------- ----- -- ------ This Permit Ex ires ] Year From Date DtIssued Date Issued Application,is hereby made to the San Joaquin Local Health District for a permit to constr cf and install the work herein described. This application is made in compliance with County Ordinance No. 549. jm.�l/: . JOB ADDRESS AND C TION_ c�J ,�-°4----X - Owner's Name-- �44 - ----- ------------- ------------------------ - -- - --------- --- - aneAddress__------`ta-.Jl---- -• ----------- I --- _Contractor's Name-- -- G .------------- ------------•3�-t : ----- --- --- - --- ------ -- ------------ - ---- •-- - Phone------------ Installation will serve:, Residence Apartment House ❑ Commercial ❑ Trailer Court- --E]----M-otel [3Other E]----------------- Number of living units: _/____ Number of bedrooms _ t __-- Number o. baths -�_-- Lot size ---_----•-------------------•- Water Supply. Publics stem P Y� y ❑ Community system [❑ Private Depth t Water Table _-______ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay Loam ❑ Clay t y ❑ Adobe ❑ Hardpan ❑ I Previous Application Made: (If yes,date-------------------) No E:1 New Construction: Yes E] No E] FHA/VA: Yes El ElTYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest weil---Sd--- --Distance rrom fo /dati�____ _".-- Materiae_.._-_ _"--.-.---- No. of compartments_.______" . - � -------Size- ------ - ------ ------ ------ -- �_$_.f'�Liquid depth--------�--- --.-- I ___Capacity-la_!' 7 I , Disposal Field: Distance from nearest wefl._-,��_Distance from foundation__.._/tt__------Distance to nearest lot line_________________ Number of lines__E_______�'------------------Length of each line----- _ f Width of trench._y_ --------------------------- Type �Jui i of filter ma#erial_--____S_,.1�_,------Depth of filter material____./�_----------- ofial lengthl� -- "---"_ - ------------------- Seepage Pit: Distance to nearest well-____.________ --____Distance from foundation__"________________.Distance #o nearest lot line"____-____.____-_ { ❑ ;,Number of pits 4 -------------Lining material------------ ------ ._Size: Diameter_ Depth 4 ---- 1 Cesspool• Distance from nearestwell_`-_"'__'.-_::Distance from foundation -- material---_------------------------- El Size: Diameter- ------------------------------------Depth---------�-=- ___�.__ ;=-= ----=- Liquid Capacity_ --------gals. • c E Privy: Distance from nearest well- -------------- ---------- ------------ Distance from nearest building �f ❑ Distance to nearest lot line...."________________ " ---------------------------------- Remodeling and/or repairing (describe):---_--------------------------------------------------- -------------•------ -------------•---------------------------- ---------------------- -= ----------------------------------------------------------------------------------------------------------------------------------------------------- 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 ireg--------- - - - -ulations of the San Joaquin Local Health District. ---------------- ------ -- Awaer and/oar Contractor) By:. - ----- --- ---i------- ----- (Title) - ----- --------- - - (Plot plan, showing lze of 7 lot, locationtof system in relation wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ � � ��, 1„ �` REVIEWED BY E ------------- DATE-__/_0 -- ' Y ------------- -----'-------------- - ---- DATE - ------------------------------------------------------------ BUILDING PERMIT ISSUED------------------- , ---- ----------- ---------- ---------------------------------------------------- DATE-- - ------------ ------- - - Alterations and/or recommendations:.-------------- --------------------------------------------------------�-------------- -------- ------- ---------- •---------- - -------------------- t --------------- ----------- --------------- ------ FINAL INSPECTION BY:-- . ----------- --------------------------------------- �� -- - --------------- ? ---- --- Date. --- --- ------- ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 6.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California a