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1-UK UNICE USE: - --------- - ------ 1 --- ---------- -------- -------- ------------ ------------------ APPLICATION FOR SANITATION PERMIT Permit No. ._% /3 3 - _... , (Complete in Duplicate) �� --------------------- ------ ---------------- - - This Permit Expires 1 Year From Date Issued Date Issued _lllL 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 Ordina e N . 549 JOB ADDRE r „L CATION_.4-7- I Owner's Na 1 1 S 1 - ------ --------- - Phone _ •---- Address_ ®� p 1 -. .'------- Contractor's Na �_- --_.---_ -�- � 7 - - -•-- e -----------•---- Phone!5�`�__--,�i�1.. Installation will serve: Residence Apartment House ❑� Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: �__.- Number of bedrooms _ .:_-_ Number of baths ___ Lot size !"a -1'--- -------------------------- Water Supply: Public system ❑ Community system' Private Depth to W able __---__- ft. Character of soiltoa depth of 3 feet: Sand ❑., Gravel E] Sandy Loam Ciay Loam El ~Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date..___----------- ) No [_1New Construction: Yes No�OFHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION-AND SPECIFICATIONS: (Noseptic._tank:or cesspool_permitted:if uEiiic_ w.er_=is,available-within 20D feet. Septic T Distance from nearest we#f_' gist r "f u a / No. of compartments__.- 4 < Material._. q- ----- -- - Siz Liquid depth-U.' G----��- ---.Capacity-_9 - Disposal Fie Distance from nearest wet_____ __________Distance from foundation-_ - ---`-__.Distance to nearest lot line____ Number of lines._4-___-l� t' Q __Len th of each lin g ---�f--- ------.Width of trench-------- Type of filter material E �---_-- -----Depth of filter material---„l-5F.!"-----Total length_.�,ff�-�-------------------- - --- Seepage Pit: Distance to nearest well______________ ______Distance from foundation----__--------------Distance to nearest lot line-------------- ❑l Number of pits.--- -- ---------------Lining material---------- -----------.Size: Diameter----•---- --- -------- Depth-------- d --- Cesspool: Distance from nearest wel----------------- from foundation..-__--------------.Lining material-------------------------------------- Size. Diameter-_'i -------Depth------ ------------------------- ------ -- -----Liquid Capacity----------------------------gals. � Privy: Distance from neo rest well________________________________ „---__-Distance from nearest buiidin H” ❑ Distance to ______ nearest lot line______________________________ g------------------------------------------ -------- ----- ---------------------------------------- Remodeling and/or repairing (describe):--------------------- ---------- _______ --------I -- ------------------------------------------------------- - ---------- -------------------------------- ---------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinanc s, n r s and�regul io of the San Joaquin Local Health District• fSi ned a g f --------- rS _ �� --- ontracfor) ( 1 -- -- __..:_Title .- ----- . - --------. (Plot plan, showing size of lot, location of system in relatio wells;buildings, et ., can be placed on reverse side). '~ 1 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ©...... ---------- DATE_._, <��C "!� - . --- -- ------------------ REVIEWED BY_ --------------------- ----------- --------------------------- ----------- ------ DATE BUILDING PERMIT ISSUED-------------------------------------------------------------- ............. ------------------•------- ------------ - ------------ DATE--- ----------•-- ----- - Alterations and/or recommendations:_-`----------------------___-- . - ----------------- t ------------------ -------------------- --------------------- -------- --- FINAL INSPEC B - - ----- -- Date------- SAN JOAQUIN LOCAL HEALTH DISTRICT LL 1601 E.No:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi, California Manteca,California Tracy,California