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rvK vrr-r�.c vac: I --- -.- Perrhit No: APPLICATION FOR SANITATION PERMIT _ _?� Sr--- r ------------ ------------------ --------------- (Complete in Duplicate} �-------�----- --- Date Issued This Permit Ex Tres 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 AND LOCATION----•---------------- ------------------•---I----------I------------ - ------------------------------------------------ --- Owner's'Name.-------, �`� Phone. --------•- r ------------------------------------------------------------------------- Address-----.. _ -----L'1 --------- --------------------------------------------------------------• -----------•---------------------------- I te" Phone..-..------------------ ---•------ Contractors INlame---------------------- �-��----------f--•- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ,/____ Number of bedrooms _�'� Number of baths _ -_ Lot size ------ Supply: Public system ❑ Community system ❑ - Private Depth to Water Table _ _ ft. i Character of soil to a depth of 3 fee+: Sand Q Gravel I] Sandy Loam ElClay Loam ❑ Clay ElAdobe Hardpan E] Previous Application Made: (if yes,date--------- -----J No ❑ New Construction: Yes ❑ NoX FHA/VA: Yes ❑ No ❑ 4 4 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) � Septic Tank: Distance from nearest Distance from foundation___• __ -_-___.Material ________________________________ wel)__________-- No. of compartments__ _r�__-___ Size �<-'71_iquid depth Capacity t Q_ .- Disposal Fie4d: Distance from nearest well`n% °-'Dista'nce from fotrndation____ -�__�_Distance to nearest lot line ;�_Q.-/ �^ Number of lines.........;2----------------------Length of each line,/_4Q__--_ 0----Width of french------ __el_-___---_--__--_-_ r s Type of filter materialS-r_ 1f _*_____Depth of filter material--/.-8_________Total length-------------------- __--___.- Seepage Pit: Distance to nearest well-----------------------Distance from foundation--------------------Distance to nearest lot line__-________----- 9 ❑ Number of pits----------------------Lining material---_-------------------Size: Diameter-----------------------Depth----------- _---------------- _ _ _ _ l r. F Cesspool: Distance from nearest well_________________Distance from foundation-------------------- materral_ ___ -_ __._.______-__-__________. ❑ Size: Diameter--------------------------------------Depth-------------------- ==-------------------- ----Liquid Capacity----------------------------gals. F Privy: Distance from nearest wel--------------------- _=_-__Distance from nearest building__________-__-___________-_-___________- ❑ Distance to nearest lot line------------------------------ ------------------------------------------ --------------------------------------------------------------- Remodeling and/or repairing (describe)= -- -- - -------------------------------------------------- -------- ----------------------------------------------- ------------------------------------••-•-------------------------------- i : -------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------.-------------------------- he rtif at I have prepared this application and that.the work will be done in accordance with San Joaquin County F11 ordinan es, State laws, and rules and regulations of the San Joacluih,Local Health District, wand/or Contractor) C - (7ifio) �(Signed)-----------BY:------------------•-----------------------T (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 y4APPLICATION ACCEPTED BY------------------------------------------------------- ----------------------------------------- DATE------------------------- REVIEWEDBY---------------------------------------------------------------------------------- -------------------------r� DATE-------- ?—r �------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------- = -------- DATE------- ----------•---------------------------------------- r + Alterations and/or recommendations:--------------------------------------------------------------------- ---------------•----------------------••---•--------------------------------------------- -•-----•---------------------------------------------- ------------------------------------------------------------------------------------------•-----------------------------------------------•--------------------------- F ------------------------------ -------------------------------------------------------------------------------------------s---------------------------- ----------------------------------------------------------------- I---------------- ------------------- - -- - ----------------------------------------------- ---------------------------------------- -------------•-------------------------------- Ji"T z�F11, FINAL INSPECTION BY - - ------------ `� = Date--------- -----------------—---------- SAN JOAQUIN LOCAL HEALTH DISTRICT Fill 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton, California Lodi,California Manteca,California Tracy,California