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FOR OFFICE USE: G ' ------ ---------- ----------------__-- ------------- APPLICATION FOR SANITATION PERMIT Permit No. ------el- ------------------------------- --------------- (Complete in Duplicate) This Permit Expires i Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. I This app made in compliance w Coun y Or inance No. 549. S7�CC� JOB AD RESS A LOCTION - - --- --- ----- `- -- ----- Owner's Name y.... Phone Address---------------••--- - - -- --------- ------ -- ---•--- __F----------------- Contractor's Name__________________ __ -------------- Pho I installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court E❑ Motel ❑ Other (�(f�JL� Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size safe : Public system`A Community system s ❑ Private ❑ Depth to Water Table _-��__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (if yes,date-------------------_.) No _ -- --N �. 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 Septic Tank: Distance from nearest welt. M--Disfance from foundation..- -"-----Materi - - -- - - -- - - -- - - --- No. of compartments-_151 -------_-.__Size_ _X---�- Liquid depth_,) -�{---------.Capacity_ __O Disposal Field: Distance from nearest welIAAI.97'_Distance from foundation__'Z__0_`------Distance to nearest lot line_____.,$+__ Number of lines. ___ _ Cl --,.Length of each line___ , --- 1*- ---------Width of trench.�4«----- -------------� Type of filter material__ ___ T_Depth of filter material__�_�--------------Tota l length-------(0_(.`-------------------___-- Q Seepage Pit: Distance to nearest well_AAa.-----Distance fro foundation__00_ _.___.Distance to nearest lot line__._.__--.---- _ Number`of-pifs_- (.� --_Linin maferiaL tr I ---- Size: Diameter._ `r ----- - g - �-�.----------Depth -.��...s ' f EE t _ Cesspool: Distance0fror� nearest wefi._______________Distance from foundation._..__ Lining material__________ __________ --------------- ❑ Size: Diameter------------------------------ ------Depth----------------------------- ----------------------Liquid CapacifiY -----------------•"gals. i. Privy: Distance from nearest,well_____.___-rte.-_____________.----------------- _ Distance from nearest building---.- I - '. ---------------------- ye �. ��..;_....^., .� �4 , ❑ Distance to nearest lot line- ----_------------------- p * e Remodeling and/or repairing (describe):----__ ------- ------------------------------•------ ------=-------------------------- - -- - -- ---"-- - -- - - --- --- - -"-"-- ---------------------------------- -----------------------------------------------------------------------------------------------"----------------------------------------------------------------------------------------------------- ------..._ I hereby certify that 1 have prepared this app' ation and that the work wil be done in accordance with San Joaquin County ordinances, State laws, and r les nd regulation of Ithe San Jo",juin Local th District. (Signed)----------------------------- By: ------------------ ---------gY? - --- - -R'- ----- ---- - - - -- K o ----"----- - r - (Owner and/orCont ractor} ite) s----- _T (Plot plan, showing stze`of lot, location of system in relatio to wells, buildings, etc., can be plat on.reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY---------- .. - ------- DATE------ �,r---� REVIEWEDBY. ----------------------- -------- ---------------------- ---- -------------------- DATE------------ ---- ----------------------------- 13UILDING PERMIT ISSUED ----------------------------- DATE ' Alterations and/or recommendations:-----_-.t.- _ -- -------.C____--------r��-+ —{� --------------- r-,r� a moi ' ----------------- ----- -- --- ---- - : _ -------- ------- - ------------------- --------------•--------- -{{ V - ----- --- --------------------------------•-------------------------------------•---------•--------------------------------------------------------------- ----------------- ------------- - ------------------- ----------------- - - FINAL INSPECTION BY__.'-.��. 1q_ - -------- ----- ----------��::_ - Date--- ------- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1501 E.Hozelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.