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FOR OFFICE USE: ��yy J� Ott ---------------------------------------- __------------ APPLICATION FOR SANITATION PERMIT Permit No. 11J-4-.-. 1�19 ---- ----- (Complete in Duplicate) ------------------------------------- This Permit Expire1 YeatiFrom Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and instak the work herein described.- This esc�r�. This application is made in compliance with',Counfy Ordinance No. 549, :, , JOB ADDRESS AN OCATIO - -R- _____ _ ______ __ p4 A-3-11 7 Owner's Name-- Phone ----•-------------- -------- Address..----------_--- - ---- ----•- ---- -------- Contractor's ------Contractor's Name • ✓�"`" --- -------------- -------------- Phone----------------------------------- Installation ----•-•------••--•----•------- -Installation will serve: Residence Apartment House ❑ Commercial ❑ Trai€er Court ❑ Motel ❑ Other ❑ v Number of living units: _1.____ Number of bedrooms -A, Number_ fj�athstiO_-_KLot size _________________________________________._____-_________-_ Water Supply: Public system E] Community system E] 'Private Depth to Water-Table -- __._ ft. } Character of soil to a depth of 3 feet: Sand ❑ Gravel El Sandy Loam E] Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-----------,--------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weEf__________________Distance from foundation-------------------Material----------------------_--------_-_-____________. ❑ No. of compartments------------- ------------Size---------------------- t-------Liquid depth--- -----------Capacity----------------------- gip ° Disposa field: Distance from nearest well__:: :_..Distance from foundation___--_/_�G_-_.--.Distance to nearest lot line_________________ Number of lines---------/-------------- -- Length of each line------7_Q_`-----------Width of french.....?-.Y- ---------------- Type of filter material-___-_,._�_Q------ of filter material_--- --------Total length________: _d___f_____________________ Seepage Pit: Distance to nearest well-----___--------------Distance from foundation-------------------Distance to nearest lot line__-____-__-______ ❑ Number of pits---------------------Lining material-----------------------Size:Diameter--------------__------Depth-------.------ ------------ --_!`p� Cesspool: Distance from nearest well-----------------Distance from foundation___. . -i - --------------Lining material----- ------------------- - - - - , El Size: Diameter------------------ ..........Depth____-______________________ _ /r- _____Liquid Capacity...-------------------------gals' 6i Privy: Distance from nearest welL_________---------------------------------------Distance1tfom nearest building-__._-.-_---_-------------------------- � ❑ Distance to nearest lot line---------------------------------------------------------------i Remodeling and/or repairing (clesc�ibe):_ " " ""i ----------------------------•------------------------------------------ -------------------•---•---•---------- - ----- ---•----- --------------- ro hereby certify that I have repared this application and'that the work will be done in accordance with San Joaquin County ordinances, State laws, and ru s a regulations of San . oaquin Local Health District < A(Signed) -------- ------------------------- ' ` ----- -- ------------------ ------- ------------------- r '------- By: - and/or Contractor] x , r (Plot plan, showing size of to , location of system in=relation•to well buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.- - -- - ------------------------------------------ DATE---- 7 REVIEWED BY ---------- ------------- DATE----------` BUILDING PERMIT ISSUED---------------------------------------------------------------- ---------------------------------- DATE----- -----------1-1- Alterations and/or recommendations:-- --------- ---------------------------------------------------------------------------------------------------~=------ --------------------------- ---------------------•------------------------------------------------------------------ ------------------------------- " ------------------------------------------------------------------ ------------- ------------ --------- ------------------------------------------------------------------------------- ------------=---------- ---------------------------------- -- ------------------------------------•----------------- ----------- -------------------------------------------- FINAL INSPECTION BY: " Date 'c• F SAN JOAQUIN LOCAL HEALTH DISTRICT j 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycarnlre Street 205 West 9th Street Stockton,California Lodi,California ,y �Manteca,California Tracy,California F.P.CO. p2 iLs i Cie e