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FOR OFFICE USE: , r L /__je�6--------------- Permit No. . l -------------------------------------------------- APPLICATION FOR SANITATION PERMIT (Complete in Duplicate) Date Issued'//—xj__'..--- --------------_-- --_._- This permit Expires 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 AN OCATION_..S�lltl!___ :_ � �/ 5'_.Cfl.. ---1h #q(,�s- '�'�-------------- Owner's Name , _ -e__ _ 1 ------•----------------- _--------- ----------------------- Phone �=�¢-� '~'��/ Address---- J .. Contractor's Name-- ---- Phone_ '' _.._ _Q. Installation will serve: Residence go Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms _;a- Number of baths __'�___._ Lot size ____________________________________________________________ Water Supply: Public system ❑ Community system privateq Depth to Water Table __ -_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy 4e1 i�R Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ 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 feet.) Septic Tank: Distance from nearest well O_'/'/ Distance from foundaation__.________________Materia��C.r_Q. lG �'T-�------- -- y ----Liquid depth___-. .�a. Ca acit _ Q/ No. of compartments------�_ ------..Size- - -- ---- -- -- P Y Disposal Field: Distance from nearest well.' Distance from foundation------ ------t._.Distance to nearest lot line _____rt----- ._.-- ____�_...._Length of each line____ ��--- .Width of trench__-_�_�.,_�____ Number of lines-nim --- ------- `` f ff of filter material_�G__OCF.�_--.___Depth of filter material___-- .___dotal---- " ------------- Type - 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` C1 Distance to nearest lot line----- ----------------- --------------------------------- ----------------------------------- Remodeling and/or repairing (describe):--------------------------------- ----------------------------------------------- ------------------------------------------------------ ------------------ ---------------- -- ------------- ------------------- ------------------------- .----- ------------------- --------•-------•---- -------- ----- - 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 Joaquin Local Health District. (Signed) ----------------------------------- --------------------------------- an r Contractor) -- -------------- - - j9wner d/o BY:•--------------------••------ ---------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -- DATE---lk-A15'--9...--------------•--------------- ------ -- --- ---------------------------------------------------------------- REVIEWEDBY----- -------------------------- • DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------- -- --------------- DATE------------------------------ ------------------------------ Alterations and/or recommendations:------- -------------- -- --------•--------------------------------------------•-------- ---•------------ -- -- ------------------ --- ---.--------------------------• ----- • .---------...___ ------- ----_ --------------_ ------------- --------. --------------- --------------------------------------- --------------- _ ____--------- ________________________________________________ R --------------------- �/ FINAL INSPECTION BY:_ -------- Date �_a'`_ `.' 6 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hat:elton Ave. 300 West Oak street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.