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FOROFFICE USE: ------ -- -------------------------------------- -------- APPLICATION FOR .SANITATION PERMIT Permit No. ----------------- --------------------------- (Complete in Duplicate) -------------- This'Permit Ex ires 1 Year From Date Issued Date Issued Application is hereby inade to the San Joaquin Local Health District for permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS ANE LOCATION..../ 53-C------ _ Owner's Name - -- ` rte---- -r---------- i ` ................ Phone------------------------------------ Address-_jz-aL-t...._..•-- CZ-41 Contractor's Name _----•?4-------- T------------------------------------ Phone. c -- -------- Installafion will serve: Residence [n� Apartment House ❑ Commercial E] Trailer Court E] Motel [I Other F-1 Number of Living units: ...-L. Number7of bedrooms-,Z:7NL1`mber of baths 1----- Lot size -707X-1e-P-------------- Water Supply: Public.system n—' ommunity system ❑ Private ❑ Depth to Water Table .--�-&ft. Character of soil to a depth of 3 feet:' Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe a—Hardpan ❑ Previous Application Made: (If yes,date )1 No D New Construction: Yes [ No ❑ FHA/VA: Yes ❑ No E— TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well ._'"_-_-.-I-Distance from foundation.._6p--f.----.-..Material--_1..................................._....-_. No. of compartments-------2i------------- Size__3--� -�-be.--Q-.---..Liquid de th----�------ Ca pacit y q.e Disposal Field: Distance from nearest well --J....Distance from foundation-_- -------------Distance to nearest lot line.47.- ...._. 'r [� Number of lines-----I--,-�----,�--------------------Length of each line---?p-.r----------------.Width of trench---^Z _.'---------.--------- S ( Type_of filter materia!_-_r> 5.A......Depth of filter ria terial_-..�8--- --.-._.__Total length----?a.`-:-_._ -------------------- Seepage Pit: Distance to nearest well..- --------- ---- from foundation..../0- --- Distance to nearest lot line-- *6- [t- Number of pits..__./-...-.- -.Lining material--- QC. -Size: Diameter-....3 -- Depth_------Z r-�--------- 'L Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---.__-...__..._---_-..._ ❑ Size: Diameter------------------ -------------------Depth------ ---------------------------------------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well---------------------------------------------=---Distance from nearest building-------------------------------------- o+ ❑ Distance to nearest lot line---------- �---------------------------- ----------------••-----�---- ---------------------- -- --- ----------------- Remodelingand/or repairing (describe):- - ----------------------------- ------- -------------------------------------------------------------------------------------------------•------------- --•-----------•-----------------------•-----------------------------------------------------------------------•------------------------------•------------- -------------------------------------------------- ----------------- --------------------------------I-----------------------------------------------------------------------------------------•--------------------------------------------•------------- ---- --------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I :�;4, and rules nd re ulations of the San Joaquin Local Health District. (Signed 9 ------------ --- ----------------------- --------------------------------- - ----(Owner and/or Contractor) By:---------------------------------------------------------------------------------------------------------------------------------- (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----------- - ----- 1� REVIEWEDBY-------------------------------------------- --------------------------------- - ------------------------------------------- DATE BUILDING PERMIT ISSUED----------------- ---- � /� DATE. Alterations and/or recommendations:._.____l- y G .✓ T!`__ ._ __------------ -- ---- - - -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------- ----- ----------------------------------------------------------------------- 111 1 ------------------------------------ ------------------------------------------ ------------------------------ t r / FINAL INSPECTION BY: v--------- -------------- Date---------------- f` 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.RCO.