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rvR Vrrll,C UJt: —��- s `------- / 1 _� -.__L� ..- APPLICATION FOR SANITATION PERMIT Permit No. [Complete in Duplicate) - Date Issued/ . ....... - - �-- -----•••----- ----��---�--� -------.--- This Permit Ex fres 1 Year From 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 compliance with County Ordinance No. 549. :JOB ADDRESS ARD LOCATION- IOwner's Name ` ------ « --- ------------------------------- -- -- Phone-------------------- -- Address-----------< _VVQ -------------------------------------------------------- ---------------------------------- 'Contractor's Name--------�--- -)4'e7V,,A --- - ----------------- Phone.. A Installation will serve: Residence [ partment House ElCommercial ❑ Trailer Court E] Motel ❑ Other ❑ Number of living units. ._.°.. Number of bedrooms.- Number of baths /----- Lot size ----_- Water Supply: Public system < Community system ❑ Private ❑ Depth to Water Table Ak4t. .Character of soil to a depfh.of 3 feet: Sand ❑ Gravel ❑E Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe�ardpan ❑ Previous Application Made: (If yes,date.....- -----) No New Construction: Yes ❑ No [nr__FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ` (No septic fank'or cesspool permitted if public sewer is available within 200 feet.) Septink: istance from nearest well------_-`-- Distance from foundation--------------------Material __-...--.._.........-_....--_-....-- No. of compartments ----------Size---- ' Liquid depth -----------Capacity-------------------- iDisp l Fief Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line---------_-.._.. Number of lines------------------------------------ Length of each line---------------------------.--Width of trench------------- ------- --------- I of filter material-------------------------Depth of filter material-----------------------Total length------------------------- -�-�--- 6 r Seepage ' . Distance to nearest well.-rte .------Distanc om foundation__..?------------Distance to nearest Ig,t line............... W Number of pits----:�-------,-_Lining material..-1___DCA__Size: Diameter-.._3_c3. ___-----Dept h._oC,C4__-_------_-. .r ----- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material -----...____--------_.-..__.-..... ❑ Size: Diameter Depth - ------ ---------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----------------------=--4-----_---------------Distance from nearest buildin ❑ Distance to nearest lot line - 9 ---------- --------------------- ------------------------ Remodeling an 4 pairin (descri ):_ ----------- ------------------- - ------ - ------------------------- ----- -------------------------------- ------------------------------------------- -----------------------------------------•--------------•---- I hereby certify that I have prepared"this applicafion"and that`tlle 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)---------------------------------------- (Owner and/or Contractor) $y:---------------------------- f �.-;` �.. ---- ----- - {Tale)- -- ..-..- -- (Plat plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY --------------------------------- APPLICATION ACCEPTED BY----.- --- DATE-------- --- ." ---------R!EVIEWED BY------ ---------------------------- ------- - ---- -- DATE------------= - -- ----------------- ---------------- -- - ------------------------------------- - BUILDING PERMIT ISSUED---------------------------------------- --------------------- DATE Alterations end/or recd mendation ______________ ► - ---------- ---------------------------------------•----------------------------•-------------------------------' ---------------------------------------------------------------------•--------------- -------------- --------------- -- ----------- ------ -------------------------------------------------------------- 7.0 FINAL INSPECTION BY:....._C -----' -------------- Date--------I--------- .-�G "� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California - i