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rvrt l/rrK_C UJC: T - - — --------- .. ------- --------------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------------- --------------- [Complete in Duplicate) - - ----------- -------- --- . . ------------ This Permit Ex ires 1 Year From Date Issued �"` 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 AND LOCATIONr�` ,,,•yr, � '�� c,, / �,r Z(•—OSO.-t-3 Owner's Name------ 4p -_ ' ------------------------------ .df�A_411�1 ---- -------------------- -------------- Phone Address---•---------- e t /. -- -_ !_ -----------------------------------------•- Contractor's Name_ --•---•--i ----------------------------- --- ------- -----------•-------------------- --------- ------------ Phone---•---•--•----•- --------•-------• Installation will serve: Residence [ J Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1__._ Number of bedrooms _X.- Number of baths -I Lot size _ - ater Supply: Public system E] Community system ❑ Private W] Depth to Water Table L4M ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ] Previous Application Made: (If yes,date_ -------_----- ---.I 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 wefi----------.------Distance from foundation------------------- Material-_.____---._-_ ci ❑ No. of compartments- -- ------- ----------Size--------------------------------Liquid depth--------------- - ------- Capacity----------- Disposal ------------ xi Field: Distance from nearest well________________Distance from foundation--------------------Distance to nearest lot line------ L� ❑ Number of lines-----------------------------------Length of each line----------_-------------------Width of trench-------------------- _ -- _ C6 Type of filter material-------------------------Depth of filter material-----------------------Total length----------------------------_--_-- Seepage Pit: Distance to nearest well_ ___Distance from foundation__3-Q___-____.Distance to nearest lot line_S�__ __... , ] Number of Pits-----/._ ------- ---Lining materials.).;?.:__-------- Size: Diameter_----.3 3__"--------Dept �------------------- Cesspool: Distance from nearest wefl----------_------Distance from foundation-__.-.----------- _.Lining material____._._.__- ___.______._ El Size: Diameter- - --------- ----- ------- --------Depth---------------------------- ------ - ------Liquid Capacity_._,,.----------------------gals. Privy: Distance from nearest well_______ Distance from nearest buildin 9 ---------------------------------------- ❑ Distance to nearest lot line______ Remodeling and/or repairing (describe':------------s- Olwu%f .'►.... °----- �. ----------- - - ------ - ------------------------------------------------------------------------------------------------------------------•----------------------•----------------- ---------------------------------------------------- -------- --------------- -------------- -------------------------------------------------------------------------------------------------------------------••----------------------------------------------------------- -- 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)_._�/f--awl -------------------------------------------- -------- --------[Owner and/or Contractor] 8Y� ----------------------------------------------------- Title __ _ _ ----------- (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--- -- REVIEWED BY------- -- ------------ ------------ ------------------------------- ---------------------------- BUILDING PERMIT ISSUED - ----------- �-------- ----.. DATE------- -------------------------------------- -------------------------------- -- -------------- - Alterations an ----------------- DATE------ ----------------- or recommendations. -----------------________-.-__-._ -------------- ---•--------- ------------------------------—------------------ --- FINAL INSPECTION --- ------------ - Date__A---7-^K-4777 --- ------- ........ ------------------- SAN ---- - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California lodir California Manteca,California Tracy,California F.F.r_Ll % n