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FOR OFFICE USE: s ............. ... . -------------•----------------.!L ...................._.._.... APPLICATION FOR"'SANITATION PERMIT Permit _.. ._.... .._.... :, '.. (Complete in Duplicate) Date Issued .............___ .. This Permit Expires 1 Year From Date Issued application is hereby made to the San Joaquin Local Health District for a rmit to construct and install the work herein described. Phis application is made in compliance with County Ordinance No. 549. - 2./2-1'7o -V>_ 7-7 JO�ADDRESS AND LOCATION..,-t?' Jc zcz.?........c..,�!LC.�i% , 7 ,' -� / y ------ z�. 1 �.:... 7 1 , . Owner's Name .... J L.e ._ �f� y-4 ---••--- .. Phone.........:..:' = Address-------•--•---•-4�7..... 19 -t�''"` ` _._._.. r Contractor's Name---------- ---- %f1-f'........ ...................................................... ................................................. Phone-------------------------- ...... Installation will serve: Residence)4 Apartment House ❑• Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:,-.1---- Number of bedrooms _. Number of baths .J.._:_ Lot size ..� . '' .. ..... .................. Water Supply: Public system: ❑ Community system ❑ ' Private Depth to Water Table .. - I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay❑ Adobe' Hardpan ❑ Previous Application Made: (if yes,date....................} No °' New Construction: Yes ❑ No FHA/VA: Yes E] No[ TYPE OF INSTALLATION AND SPECIFICATIONS: 11� (No septic tank or tesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well.................Distance from foundation............- Material...................--------...................... No. of compartments.........................Size................................Liquid depth---....... ..............Capacity Disposal iFDistance from nearest well--./7.5.....Distance from foundation.....11P.......Distance to nearest lot lineZZ .....____. �. Number of lines---------2_....r_r............Length of each line_ ;a. -5'� ..Width of trench..___2 f -1�................ � )� Type of filter material-.01--r' .:Depth of filter material_-l_er'.............Total length......./.5...._._.._.............. Seepage Pit: Distance to nearest well......................Distance from foundation....................Distance to nearest lot line................. ❑ Number of pits......................Lining material...-.........--........Size: Diameter........-.--...........Depth-----................I........... ; Cesspool: Distance from nearest well.................Distance from foundation....................Lining material.................. -........._._.._.._ ❑ Size: Diameter------ • ............................Depth----------------------•--------------..........Liquid Capacity...........--....... -------gals. - _.__._._Distance from nearest building..._._.....-........._............ rrivy: Distance from nearest.well_-_____r._..____.__-.------------- _.-._-•. ❑ Distance to nearest lot line..........................................-•---•-•------..............,.......-------.................. .................. ;.._..._.......... Remodeling and/or repairing)(describe):.............•---•-----••------•---...------..............---•..---........--•-•--•-•--•-------•-•- •-•-•--•-----••---.... ................. f .................................................. ...........................................................................................................................I---------I....................... y Y 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 laws, and rules and regulations of the San Joaquin Local: Health District. (Signed)............................... -----••----...----------------•--•--• • --•---------.................... ............................. ------(Owner and/or Contractor) ' .-.....----•--------•---.--------•-------------•-------•- .....-.-(Title) - (Plot plan, showing size of lot;"loc ion of system in relation to wells, buildings, etc., can be placed on reverse side). f. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY................ •------•-----•--•---•--..... �_(� A�f� -- _ ! REVIEWEDBY..........................l ............................................................. .I " D - t BUILDING PERMIT ISSUED--`'l.............. --------------------------------------- ` A Alterations and/or recommendations:..................................................... <J. --•--..................................--------i-- I f � 1 I b 11. . ................•--•-------.._................... ............................................................................................................_.............--------------...................... • R• .......................... ..._....--._.....:i...........-.._.-- �• _.... . ...................----..........-•--•----.....---........---------•----•------•--•--....._.. .......................... FINAL INSPECTION BY:..- A.__..._._ 2 .......... ................•--- Date...........�..---•--------....�C�?...�.........-----•------...---- I! � !I SAN JOAQUIN LOCAL HEALTH DISTRICT M1 1601 i,Naalton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,Callfwnia i Lodi,California Manteca,California Tracy,California ES S REVISED 8.59 3M 3••63 F.P.CD. II