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FOR OFFICE USE: ------------------ ------------------- ------ / --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .. _...._.�-.....-.._ I --------------------------------------------------------- (Complete in Duplicate) . Date Issued _________________ -.--_------------------------------_..--.----.----- - s Permit Expires ll Year From Date Issued i __ This _ _ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I This application is-•maderin.compliance with County Ordinance No. 549. I JOB ADDRESS AND LOCATION... La'k_. -`�-- •l P _ Owner's.Name....-- --- -- ---- ---- f----------------------- ------------ Phone..... f Address.- f 1 Gf.. tjw _ - Contractor's NameQ/+ ^Yt 4..--------•----------------•-•--- -------- Phone Installation will serve:tesidence ❑ 'Apartment House,❑:Commercial_❑„,�TrailerkCourt ❑ Motel ❑ Other ❑ Number. of living units:.__------ Number of bedrooms ----_--- Number of baths ----.-_ LoIts ize ---------------------------------------•---------___----..-.. Waterr Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel'E] SandyaLoam❑ Clay Loa ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: {If yes,dcie--__-.-_.- --.--I N�n�' :Nbw:Cohstruction.- Yes El No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:. k t (No septic tank or cesspool permitted f public sewers is available within 200 feet] •4.A{{�=i iY' � .w hA �. £ Septic Tank: istance from nearest well. -.-t-_Distaricerfrom foundation_----1 _----_---Material- -.�E �:T..__.L�fa � ._JX No. of compartments-------- __________Size.. 2� ,iC.,ir_._ _-Liquid depth-------- -t-------------CapacitY_ owl 4rl1L Disposal Field: Distance from nearesf well's[-) .,_ I'D isfance.Kfrorn fou dation_4G7.-#-_-.-.Distance to nearest lot line_---T~ I Number of line"si-------- ------=-------------Length of each line-_-._7 ------..........Width of trench-----gAil.------------------ Type .---------------- T e of filter material-__. 0 - De th of-,filter material----- --- --------- length:-----J-.,0--..........--_------.-- SeepageyPit: Dlis�t�ance to nearest well-----------------------Distance from fou�n�dat ....................Distance to nearest lot line----------------- 0 Number.. pits--- - ------LininC1Tmaferial------- ----- -- Size:tbi-�mete ._--Depth--------------------------------- Cesspool: Distancd from nearest ------------Distancefrom foundation---------------------Lining material--------------- --_------. I ❑ Size: Diameter-------- ----------------- Depth---.---------------•------ -I------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well_.-. -- _R -_ �'-D.ils a_n�e4rom earest building----------------------------------------- -1 .- Distance to nearest lot line -; - ❑ -------------------------------- Remodeling awn %or repairing (describe);--::�;-.-_ -r.,"".�"w........-- Y......:.................•..._.__0. - "' =_ -------------------------------------------------------------A--------------------------------------- .._.... ---------------•----- --------------•---------- ` .•""'F' - ------------- ----- : t I hereby'certify lhaf,l'have�prepared this'ap,plication and that the'work,will'be done in`accordan a-with San,Joaquin.County 3 ordinances, State laws, and rul;�s:and —`patron"s-af°the,SamrJoaquirt-Local•Health-DiOriat- "�,,,''�-"��-�- _ - .«•.+rM�r_�-�...��.+ +l�s�w-., (Signed)..---- --- -- - ---------------- ---------�------------------------------------------------------------ -------------(Owner and/or Contractor) Byl {Title]---------------------------- ----------------------------------- (Plot -- -------------------(Plot plan, showing s' �of lot, location of system in relation to wells, buildings, etc., can: be placed-on reverse side). ( FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------------------------------------------------- ---------------------------- ------ DATE----.----------------------------------- ------------------- REVIEWEDBY----------------------------------------- P---•------------------•-----------------------------------------=-- -----------... DATE------------------------------------------------------------ BUILD.ING PERMIT ISSUED.............-•------------------------------------------ - :----------:----------------------- DATE-------- --- Alterations and/or-recommendefions--------------- ----------------------- - ------------------•-----------------------------------......_..--------------------•---•------------------------...--------------•---...---------------------•------------------------------•--------------------••----•---- --------------------------- FINAL INSPECTION --. ------- Date---- Q ---Cc SAN JOAQUIN LOCAL HEALTH DISTRICT 130SoJih•America"ri Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 4 E9-9 REWSE0,e•59 F.R.00.2M 6.60