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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No, ----------- --------------------------------------------- ................................---...............-------- (Complete in Duplicate) _ O ed -------------.--...--------- ........................ This Permit Expires 1 Year From Date Issue Oct. Application is hereby made to the San Joaquin Local Healfh District for a permit to ton m I the'red herein descri This a li�cation is.made,in,compliance with County Ordinance No. 549. Q JO ADDRl=55 ANDD LOCATION- Ld�'. �!1 --- --1Wf_-_ -spa . .................. Owner's Nam�ef /t2 _ �.... Phone Address................................!Qs.. - 7...__......._.__......- Contractor's Name................&rt.! -d-. .. �...------....._........ Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Numberof living units: _`" Number of bedrooms ____'"Number of,.baths ___ Lot size ______________________-__.__._..-.-•................. ...._ Water Supply: Public system ❑ Community system ❑ Private Z--*Depth to Water Table .._..__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 2-1-11c1ay 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 nk: Distance from nearest ".r...Distance�from foundation----I-F...........Material.....421-4............................. _ -No. of compartments..--- .. ............. Liquid depth__-.----�_............Capacity_F?P?!R. .. . � Dispos Field: Distance from nearest Distance from foundation._..!P2---_.--Distance to nearest lot line_ Number of lines...._._..I_...._. Length of each line-----44-x----------------Width of french....-��---.-1....................... t' f Type of filter material_____S --------'..Depth of filter material____.- ---__._Total length.._._t!!rj�!......I......... Seepage Pit: Distance to nearest well______________________Distance from foundation....................Distance to nearest lot line---------------- El _._....- ---._❑ Number of pits----------------------Lining material........---------------Size: Diameter.......................Depth----.-..-------.--.-._.---.---.-- Cesspool: Distance from nearest well.................Distance from foundation....................Lining material--•........•--------------.___-___._- ❑ Size: Diameter.-.............................------De,pth--..................................................Liquid Capacity............................gals. �1 Privy: Distance from nearest well.................................................Distance from nearest building.......................................... ❑ Distance to nearest lot line.......................................................................-----------------------------•-------- ------------------------- Remodeling7(describe):---------------------- .................................------- -_-------------- ......................................................... -----------------------------------------------------------------------...............................................................-----------------....... ........................................................ -..............................--------------------------------.--..--.....--•--•--•-----_.......................----._--.-------------------------••-----...---•-------•----.----- --- .._.----------•---...._... ---------------------------------------------I---------------------------------.......................................................-------------- ---------------------------------------------------------- I 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, and rules and regulations of the San Joaquin Local Health District, l (Signed)----- ------�^�r and/or Contractor) -- . . By:......................... r ----- ------------•------------------------------------------(Title)---------------------.-.----- --•-------- -------._....---- (Plot plan, showing size of fat, location of s em in relation to wells, buildings, etc., can be placed on reverse side). / FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..I. .._--- e!� y-r ^- _,% -----------------------------•--------------------- DATE-.//-~ ~/ ..--• ..................... REVIEWEDBY--------------------------------------------------------------------------------------------------------------------------- DATE........•--------------------_ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------.._...--I.......... DATE------------------------------------------------------------- Alterations and/or recommendations:------------------- ---------------------------------------------•---.................... ------------------------------ ----------............ ........................................................... ........................................------------ ----------------------------------------------------------------........................................... ------------------------------------------................... -------- --------------------------------------------------------- ---------------------------------------------------..................................... .--.---.-•---............................• -............................................... -•-----------------------------------------_--..-.----------------------------._................. -.--.-------- FINAL INSPECTION BY: r '�t'�'-. i.R.: Date...-'----------------------------------------------------------------•--- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601.2.Ha:ettan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.F.0 O.