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FOR OFFICE USE: ----- ---------------------------------- ------------ Permit No. .jk.r,- APPLICATION FOR SANITATION PERMIT ------- ----------------------- (Complete in Duplicate) Date Issued .4_- This Permit Expires 1 Year from Date Issue 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. i --- - ----------- -------- ----- -F------ Z`�`�Pls oneQp J� Q _JOB ADDRESS AND LOCATION________ _ _ Phone- Owner's Name----- 1 ---•-- r--------------------- ----- - 1 : --- Address------- - -.__ --lIl Tr Contractor's Name- ----- •-- ------ T' Installation will serve: Residence ,[Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ !,� ---- ---. -Q-------X--��-��----� ------ ---- Number of living units: _-/__ Number of bedrooms _T_ __ Number of baths __�- Lot size Water Supply: Public system ❑ Community system [5"frivate ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe © �arclpan ❑ Previous Application Made: (If yes,date....................) No lew Construction: Yes �o ❑ FHA/VA: Yes ❑ No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se tic Tank: Distance from nearest well--_�D O-Distance from foundation-_-IA---------- ---------- -- ----.Material_-_--___ p �--------Ca Capacity. teas�o ❑ No. of compartments- - -----._Size---�� Liquid depth. p Y f Disposal Field: Distance from nearest well--_/.pQD.."Distance from foundation___-..011C--/---Distance to nearest lot li e-___ ------- ❑ t� Length of each line___ Q_----___-_.Width of french....... _--.-- Number of lines -------- g �, .t /� Type of filter material___/ __ vy pth of filter material_. -- 4fTotaf length___--___ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line_-_____---._._-_ O ❑ Number of pits-------------- -------Lining material----------------------.Size: Diameter.----- ----------------Depth-- ------------------------------ Cesspool: Distance from nearest well_________________Distance from foundation....-.------------- Lining material__.-- _________------------------- ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity -------------------------9 Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line----- ------- ------------------------------------------------------------------- ---- ------------ - ---- -- --------------- ---------- Remodeling and/or repairing (describe)------------------------- ---------------------•------------------------ ------ ------- --------•-----------•------------------------ ------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ------------------------------------------------------------------------- ----------------------------------------- --------------- --------(Ow r Con ct _ .:... ---------------------------------------------. --------- (Owner and/or ra or --- -- --- ----(Tit e)----------- - - - -- - - (Plot plan, showing size of lot, location df sy em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY a.2/F c67 APPLICATION ACCEPTED [i -------------------------------- DATE LQ[_�-,�i g - -- ---- - ------------------- REVIEWEDBY--------------------- DATE-------------------_---------------------------------------- BUILDINGPERMIT ISSUED----------------------- ----------------------- DATE---- ------------------------------------------------------- Alterations and/or recommendations------------------------ - ------------------- - ----------------------------------------------------------------•------------ -------------------------------- - - ----------------------------------------------------------------------I--------------- ------------ -------------•----- FINAL INSPECTION /t---- Date --- !-C -`Y-- ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kaselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C O.