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I t t-UK VPrIC t UJt: t� ----- Permit No. _21 ArPLICATION FOR SANITATION PEWIT - _ --------------------------------- --------- ---------------------------------- (Complete in Duplicate) Date Issued _ _ -----------------..... ... This Permit Expires 1 Year From Date Issued k • Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. This-application is made in compliance with County Ordinance No. 549. ' yy --- _ -- --- --/--�-- -____ < -}---- Q 1 -------JOB ADDRESS AND LOCATION__ _ _ --AddOwnersName- ---•-----•- ........-- ---- --------- �----- --------- ------ Phon �-�•-- --- Address--- ress----•----------- 2 ------. ... e..---- ------------ - -- � ' -----• ---------- -----•----_-----•----- Contractor`s Name-----------------------•--_- - - Phone ---•-•----. ------------. Installation will serve: Residence 14 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __2__ Number of bedrooms _Sl. Number of baths _;�--__ Lot size ---------- _________________ Water Supply: Public system ❑ Community system ❑ Private [k Depth to Water Table sSft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobejo Hardpan ❑ Previous Application Made: (If yes,date---------___--------) No R( New Construction: Yes X No ❑ FHA/VA: Yes ❑ No L!Z TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest welL_�W______Distance from foundation__.�6-- Material______ _ _________________________ ____ __ �' No. of compartments____-_Z------------Size__ _ -a'_1/-:__.Liquid depth______._.-/-.____..Capacity�eW----- 4z disposal Field: Distance from nearest well--_ �/......Distance from foundation_- 6._�____.Distance to nearest lot line_--67-1 ._�_... Number of lines_____________, w ... _ .-..___ Length of each line- ��--�d'-��.Width of trench------s�--�____________________ Type of filter material_-_-_/_�OZ�----Depth of filter material..__ -.'.�_--_Total length--------�a-_�_._�___________ __ r /�i 67,7 Seepage Pit: Distance to neares,t�`ell__�C� .._ _-__Distance fr m f undatlon__________ ______Di�n��to nearest lot line.-�.____._.-... Number of pits.___*Pff6L-. ...--Lining material___ --__.Size: Diameter__....... .......Depth--_or�___________.-. Cesspool: Distance from nearest well-_-_---____-_-_Distance from foundation______------_______'lining material__-_.____________...__--.-_-__-_----_. s ❑ Size: Diameter----- -------.Depth---------- ---------- ---------- - --------------Liquid Capacity----------------------------gals. } Privy: Distance from nearest well----------------------------------------___...._Distance from nearest building.-___._---_-.._-_-_______-_-___..___-._. ❑ Distance to nearest lot line---------------------------------- --------------------------------------------------------- ------------------------------------------------I and/or repairing (clescribe):---------- -----------------------------------------------------------------------------------•-•-------------------•---------•-----------------------•-- -------------------------------------- ------------------------------------------------------------------------------------------- --------------------------------------------•-•---------•---------------------------------------------------------••--------------------------------------------------------------------------- ------------------------------------------------------------------------- r 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) --- -- ---------------------------- - - ------ ------------------------------------------- -------------- -Owner and/or Contractors By� ------------------ ------- ---------------------------------------------------------(Tit]e}---------------------------------------- (Plot plan, showing size o ot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- DATE----- 1 ----------------- �:. REVIEWED BY-- ------------------------------------------ -------------------------------- ---------------------------------------------- DATE----- ---------- -- --------------------------------------- JA BUILDINGPERMIT ISSUED--------------------------------------------------------•---------------------------- ---------------- DATE------ -------------------- -- -----_ `4► Alterations and/or recommendations-------- --- ------------------------------------------------------------------------------------------------------------ •-------- ------ F - ---------------_--.-_---_..-__-_______...-_____..._____-._...____._..--...-.-.__.___-__..._.__-._______-___-_._-._____________--___-___._.___.__---_-_--_-_..__-..._.___-_-.-.________-__--._._--___-.---.-..-_-_-.___._ -------- ------ --- - - -- -- -----. .---- -------------------------------------------------------------------------__..._._---------__.__...__.__--__..._.______..__..-----.-._....----_-___---_.._______...._____.____---....._----------._-_-._-_---_----.___-_--__._ .........................................................._--------.._.....-_._.-.------.._-.--_._-.-.--__--..._-----__-_--------------.-•__---_.-.---....-------_...__.--------.--.---------------_--.---------------------- FINAL INSPECTION BY: - ------------ --------- Date--- ------- ------------------- ----- - ----------------------- L r SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street i Stockton,California Lodi,California Manteca,California Tracy,California