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FOR OFFICE USE: ------------------------1-- -- ------------------------- ` APPLICATION FOR SANITATION PERMIT Permit No. ------------- -- --- -'-------- -----------------I------- -- ---------------------------- (Complete in Duplicate) ----------------------------------------------------- This Permit Expires 1 Year From Date Issued Date Issued _7-_-��.- � Application is hereby made to the San Joaquin Local Health District for a er it to nstr tan incl trei rbed. This application is made in compliance with County Ordinance No. 549. h ,, A JOB ADDRESS A LOCATION__ T- IJ/ �7 ��; aJ T�✓ f/ a = �y9f.-.. Owner's Name CUA- ___��_.,----- ---------------•---------------------- --------- - - - ------------------------------------- ----------- ---------------------------------------------- --•---- --------------- ---------- ' _t -------- Contractor's Nam - - - -_ ___ . -----4n Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ KAotel ❑ Other ❑ Number of living units: J._- Number of bedrooms Number of b s ---/__ Lot size __- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ I Previous Application Made: (If yes,da'te.--- ---------------) No ❑ New Construction: Yes ❑ N FHA/VA: Yes ❑ No ❑ E TYPE OF INSTALLATION AND SPECIFICATIONS: E (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic Tank: Distance from nearest w ll_r_OQ_.._Disfan e fro fo tion---- p n - - ' No. of compartments_ -------- Liquid depth.- --�.---....--Capacity--/�_lQ-- D' 9saI Field: Distance from nearest well..................Distance from foundation.-------------------Distance to nearest lot line----------------- Number .____.- -.----Number of lines-----------------------------------Length of each line-----------------------------.Width of trench-------------:--------------------- Type of filter material--_- ---- ---Depth of filter material----------------------Total length---_-----_-----:----.-_---_---------_-.- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-------.--..----_ 1 [] 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------------------------------------------------- from nearest building------------------------_-----..---------. ❑ Distance to nearest lot line------------------------------------ --------------------------------------------------------------------------------- ---------- ---- ------- I Remodeling and/or repairing (describe)----------- ----- --•-------- ----- ------------- ---------------- ---- � -- - ------------------------------------- G ---------------------------------------------- --- -- --- -- ------ -------------------------------- - ---------- ----------------------------------------- --------------- ----------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------- ------- ---- 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, &I rules and regulations of the San Joaquin Local Health District. e (Signed)-------------- ------------------------ (Owner and/or Contractor} l SEPTIC TANK SERVICE BY� 2 1 � rt}fr�erflve_;— tfiE3:5.3S i--------------- -- --- -i (TitEe}------------------------------------ (Plot plan, showing size of lot, location of system in relation t wells, buildings etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY---- --------------------------------------------- DATE--- - t ----------------------- REVIEWEDBY------------------------------------- ------------ --------------------------------------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED----------------------------------- -------------------------------------------------------- ------ DATE------------------------------------------------------------- Alterations and/or recommendations---------------------------------------------- - -------------------------------------- ------ ---------------------------------------------•------ ----------------------- -- --------- ---I--------------------------------------------------------- ----------------- ---------------------- -------- --- ----------- ------------- --------------- - --- ------------------------------------------------------ ---- ----------------------------- ----------------------------------------- ----------------------------------- FINAL INSPECTION BY:.._ - --. ----------------------------------- Date----- _- -0--._ ---. . -------------------------------------- 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 F.P.c o.