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rvrccirri L ust: i ----------------------------------------------- Fp - ------------------------- ---------------- ________- APPLICATION FOR SANITATION PERMIT Permit No. (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 complianc 'e with County Ordinance No. 542._, JOB ADDRESS AND LOCATION ._�_____'�Du74 kA_P4_Q -- Owner's Name--------------- j`� -F3 C - -1\[ � -�/ S P —. .------�/��--E_ _ ---- Phone Address----------------3.00--------I�A_&S0-5 �_��.. - MO ---5TO--- ------ •------- Contractor's NameLl_ __. _P!3_ _�9r� - •--------------------------------------------------------------- Phone--------------------- Installation will serve: Residence ❑i Apartment House ❑ Commercial railer Court [] Motel ❑ Other ❑ Number of living units: ___-----;Number of bedrooms -------- Number of baths -------- Lot size } Water Supply: Public system [ICommunity system E] Private [,Depth to Water Table _ ft. Character of soil to a depth of 3 fest: Sand ❑ Gravel ❑ Sandy Loam ZClay Loam ❑ Clay ❑ Adobe I] Hardpan ❑ Previous Application Made (If yes,date.......-------____ _ l No 2--lNew Construction: Yes V?"N"o ❑ FHA/VA: Yes ❑ No 0� TYPE OF INSTALLATION AND SPECIFICATIONS: �. jg(No septic tank or,cesspool p6mitted if Public seweis.available within 200 feet.) Septic Tank: Distance from nearest well__, d_.-._Distanc from foundation___��__._.__ Material--C'Q�1lCR 7- No. of compartments------ -------------Size_-- /rJr�_X_'�___Liquid depth__/��- Capacity._-�Z_o ---_ t Disposal Field: Distance from nearest well---.SC)----Distance from foundation___/(1_____.___Distance to nearest lot line of lines___.--____"7-----------------Length of each line------- __- ___ 7�.-�--- . Width of trench--------�-�--- i { Type of fitter material___ ._ ---Depth of filter material .........Total length_________________:__- i Seepage Pit: Distance to nearest well._.-------------------Distance from foundation____.____-_-______.Distance to nearest lot line_______.___-___- ❑ Number of pits'-------------- _Lining material---------- ---------- Size: Diameter_________- Depth ------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__________.-__-.____ ❑, Size: Diameter--- Depth -----Liquid Capacity----- -------------gals. Privy: Distance from nearest well---___----------------------_-----------------._Distance from nearest buiidin ❑ Distance to nearest lot line--- - -------------------- Remodeling and/or repairing fdescribe):--------------------------------- ---------••----------•---• --- 1 I ----------------------------------------------------------- I ---------------------------------- ----------------------------------- ----------------- --------------- ------------ t -------------•--------------------------------------------------- ---------- - . ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------- - I hereby certify that I have prepared t is application and that the work will be done in accordance with San Joaquin County ' ordinan�s State laws, and ru nd reg ations f +he San Joaquin Local Health District. ' l r (Signed)_ -- _, - _ (Owner and/or Contractor .., -- --- t R�--------- Ti+l@------ - (Plot plan, showing size of lat, location of system in relation to wells, buildings, etc., can be placed on reverse side). �U ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------TI--R 0- ------------------------------------------------------------------ DATE------------- REVIEWEDBY--------------------------------- --------------------------------------------------------------------------------- DATE-------------- BUILDING - ----•-------- -------------------••------- PERMIT ISSUED------------- - ----- ----------- DATE Alterations and/or recommendations_--------------___ ------------- ------------------------------------------- ---------- i --------- .....------------ -- FINAL INSPECTI - Y. ---- Date �Q- -------- ---- ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street d 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.c O.