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FOR OFFICE USE: — -- --------------------------------------------------------- ....... -....... ----___________.___._______________.... APPLICATION FOR SANITATION PERMIT Permit No. ___. .. __..... - --------------------------------------------------------- (Complete in Duplicate) ------------------------------ -------- This Permit Expires ] Year From Date Issued Date Issued ...4q4/1 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thwork herein desc`Zed. This application is made in compliance with Count Ordinance No 549. ; . J08 ADDRESS AND Owner's Name 4 ------------------- -.... e ----- -------------------------------------------------------------------- Phone-------------------------- ------ Address. ...... ----------------- - ------------------•--• ------------------------------I.............--•------------'- ---------- Contractor's Name--- --------------_- -- --------•------------------------------------------. Phone....------------------------------ Installation will serve: Resident Apartment House ❑ Commercial ❑ Tralijrr Court ❑ Mote! ❑ Other Number of livingunits: -_1---- Number of bedrooms .13__ Number of baths _1__ �_ �ot size --•----•��►'�----------------- ---- -----------•-- Water Supply: Public system ❑ Community system ❑ Private (A Depth to Water Table Za ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam X- Clay Loam ❑ Clay ❑ Adobe)d Hardpan ❑ Previous Application Made: (If yes,date____________________) No New Construction: Yes K No ❑ FHA/VA: Yes ❑ Nox, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public 99sewer is available within 200 feet.) Septic Tank: Distance from nearest well_:_b___G1----Dista fr f nd ti Mate iaL .._�- �f °�` -•---------- --------/ �. 1 �J iVo: of compartments_ ____________________Siz�_! �___+ iqu�d depth____.__. ...___...._Capacity__i_ _ -- ____ Disposal Field: Distance from nearest well_10___ _Distance from foundation.___-]-y'_.__.Distance to nearest lot I'ne_ Number of lines___ Length of each line_ _w_ Width of trench..___ l/ +.� b�-- ?- Type of filter materialr .i-P -_Depth of filter materia-- _-.� _!/._Total length---.,.- �_____________________ . „yj,sr Seepage Pit: Distance to nearest well----------------------Distance from foundation....----------------Distance to nearest lot line-_____________-- ❑ Number of pits----------------------Lining material----------------------.Size: Diameter------------------------Depth--------------------_.----------- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material -----------_____________._. ❑ Size: Diameter------------------ ------Depth----------------------- ------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well--------------------------------------___________Distance from nearest building ____________.__._._________. I ❑ Distance to nearest lot line--------------------------------- ----------- ------------------------------------------------------•----------------------------------------- Remodelingand/or repairing (describe):------------------- --------------------------------------------------------------•--•---------•-------•--------------- •--- ----------------._- r -----------------------------------------------------------------------•---"------------------------------------------------------ -------------------------------------------------- --------------------------------- I hereby certify that I 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 oaquin Local Health District, J (Signed)---- ----------------------------------- -( 'or Contractor) By:-------------------------------------------------------------------trela�f* Afo -- ------- - -----�`---------{Title)- � - ......... .................... (Plot plan, showing size of lot, location of system ls, buildings, etc., can be paced d on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------------------- DATE--------------- REVIEWED BY ------- - ------- ----e----------------•---------------------------- DATE------ I �� BUILDING PERMIT ISSUED---------------- ---------------- -----------------------------------------------------• DATE r Alterations and/or recommendations------- ----------- -------------------•--- •-------------------------------------•-•--•-•----....------------•--------------------.••" ---------------------------------------------••--•------------------------------------------------------------------------.-_..--•-------------------------••- -------------•---.._..-----•------------....._....... ---•----------------------------------- ----------------------•----------------------------------------------------------------------------------I-•-----•-------------------------------------------------------_-------•--- •------ --- ----------------------------•------------------------------ -------------------• -------- ---------------------- --- FINAL INSPECTION BY: - Date--------------- r - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California EG-9$1Ev11=e-59 P.P.co.2M r-so J F