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t-UKUI-I-If.t USt: .-- ---------- APPLICATION FOR SANITATION PERMIT Permit No. 10..................... --------------------------------- --- --- (Complete in Duplicate) ______________.___. ._.__..___.._- 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.•---4,�t�'! A/&UJ--- ---------- G" !/ ' - --------------------- Owner's Name_ --------- Phone----••------------------------------ ..�� Address...__ ---.1+l------- ,�--•------• -- - ----------„c.�p,------------------------------------------------------------------------•-----------------•------------------------ Contractor's Name --rte-- -- Phone..----------------_---- .��,,,� Installation will serve.. Resi ei�cApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ __ Number of bedrooms ___ Number of baths -;Z-- Lot size ------- -- .____IS ___-_________._____ Water Supply: Public system [ Community system ❑ Private ❑ Depth to Water Table -4--- ft. Gil Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan C]- Previous Previous Application Made: {If yes,date-----------.........) No 52 -New Construction: Yes �FVo'❑ FHA/VA: Yes ❑ No [rte% TYPE OF INSTALLATION AND SPECIFICATIONS: _ _. I,– (No(No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4 Septic Tank: Distance from nearest welt__—--------Distance from foundation/Q__f_____.____.Materiai__.. ------------------- No. ................. __-Size--- ?�_� _ '�s_f_ Li uid de th-------I.`...__...._-Capacit /2� No. of compartments..-2—____________ q p, Disposal Field: Distance from nearest well ."_------------Distance from foundation__lQ__`_-___.---Distance to nearest lot line_.s�:____00..... c�(� Number of lines-------Z-------- ----------------Length of each line_w_5�---------------------Width of trench__�,-}__''----------------- ` Type of filter material 1PaK1 ____.__Depth of filter material---4'__...------- otal length----- -dv_!----------------------C— Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Disfance to nearest lot line_____.____.______ ff� ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------- f--------Depth--------------------------------- 4 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------- Lining material-------_____---__----___________.__. Size: Diameter--------------------------------------De th------------------------------------------------..._Li u'id Capacity als. ❑ p q p Y- - -- --- g Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.--_._.------------------------------ _. ❑ Distance to nearest lot line---------- ------- -- ---------------------- --------------------------------------------------------------------- ----- ------- Remodelingand/or repairing (describe)=-- ----------- ----- -- ------- --------------------------------------------------------------- -- ---------------------------------------------------- -------------------••------------------•---------------------------------------------------------------------------------------------- -------------------------------- ----------------------------------------------------- --------------------------------------------------------------------------------------------•--•---- -------------•-------•---•-----•---•--------•--------------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------- ------ 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State7l ws, and rules and regulations of the San Joaquin Local Health District. (Signed) ------- --------- ----- --------------------------------------------------------- --------------------------- -------------- ----(Owner and/or Contractor) By:-------------------------------------------------------------------------------------------------------------------------------------(Title)---------------------- --------- -- ------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). �� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ f ' _. --------- ---------- ---------------------------------------------- DATE------------=.`._-.XLO-------------------- REVIEWED BY---- -- ---------------- -- ---- --- ----------------_ DATE--------- --------------------------- - --------------------------------------------------------------- - - BUILDING PERMIT ISSUED------------------------• -- - - - - ------ --------- DATE--------------------------------- --------------------------- -- - - -------------------------------------- -- --- - Alterations and/or recommendations:-•----- --------------------------- ---------------------------------------------------------------------------------------•-•----•------------ ------• ----------------- ----------------------------------•----------------------•- ---------- ---------------------------------------------------------------------•--------------------------------------------------------------- ---------------- ---- ------------------ -------- ------ -- -- ------------------ - --- . --- ----------------- ---------- --•------------------ --------------------------------------------------- ---------------------------------------- ---------- r _._ _ -•----------•..------. ----- . . .------ -- ---------------------------------•---------------- ------ --------------------------- ------------ -------- FINAL INSPEC N BY: -- --- - Date T �t2(P 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 Tracy,California F.p.CC.