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FOR OFFICE USE: ----------------------------------------------------- ----- -------- --- -- ---- -- -------- -------- - - APPLICATION FOR FOR SANITATION PERMITPermit No. .._�-�-1-�:.�� ----------- --------------------------- --------------------- -- (Complete in Duplicate) Date Issued ------------------------------------ _ _ N This Permit Expires 1 Year From Date Issue _ _ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the wor rein de r.�b d. This application is made in compliance with County Ordinance No. 549, s JOB ADDRESS AND LOCATION�Q�--��- �s-�. - . �-----,�-r---��- -�-� ^--�- - s Phone---=•------------------------------- J -...-Wi_Ieji ----------------------------------- Owner's Name / �,/ ` -----•---------------- Address----------------------- Contractor's ------ ----- - ----------------------- �Q�"� Phone.------•--------•------------------ Contractor s Name--- -- - --f�-=��-�..f"'J'!------ ----- ------------�-�------ -----------•---- -�---------------- ,. Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence [Apartment House#❑ ❑ c� Number of baths 1L. Lot size -� L�.f" '--------•--------•--------------- Number of living units: _-�_-- Number of'bedroom5 . ;7V ft. Private /Depth to Water Tabl Ele - Water Supply: Public system Community system U, ❑� L Adobe Hardpan&].— Character of soil to a depth of 3 feet: Sand ❑ Graveh❑ Sandy Loam ❑ Clay Loam [IClay ❑ ❑ Previous Application Made: (If yes,date--------------------) No [go'New Construction: Yes g? No ❑ FHA/VA:-Yes [t_.No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I. within = feet. permitted if ublic sewer is available w ) (No septic tank or cesspool per p ` ` - Material-_,�-�- ------- �-------- Septic Tank: Distance from nearest well--_s-49----Distance from fo.4ndation--./ --- - -- Ca acit A��----- No. of compartments Size- _ P � �-`Guid dept` P v1 ��_----_Distance to nearest lot line-f ------- p • ° Disposal Field: Distance from nearest well.- .Q-__..-Distance from foundation -- Width of trench.-�----------------------------- ^� Number of lines:_-- Length of each line- p�el------ r Type of filter material f G° Depth of filter mat eriaL.Zle-----`--Total length-- - --------------------F-_--- ' r Distance from foundation- �__,�'.Distan e to nearest lot line- - -___---_-- `� Seepage Pit: Distance to nearest well--t_�_jP�_J �i Depth -e Number of pits_ -. -_ :Lining material_/e4P4 �- SizeDiameter-- 1 Cesspool: Distance from nearest well-------------_ Distance from foundation.- Lining material__.--...-.-.__---__-----_----.--- ❑ Size: Diameterl----------------------------.----eDepth----------------------------- ------ --------------Liquid Capacity --------------------------gals. E Distance from nearest building....__----------------------------------- I Privy: Distance from nearest well--------------F!'-__--------------------- t -- Distance to nearest lot ine--------------`s'-f-- --------------------------- ------------------------- l-- ---- ------- - �g 1 � °d/-- !� ✓/ .-� llr ` ---------•--------------------------------------- Remodeling and/or repairing (desc4ribe):-..----- ---yi► M / _.-..----------------------- ------------------ ---- ------------ -------- ¢------------------------------------------------------ = 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. Contract (Signed)_ -------------------- f ------------------- ------------- By:----------------------------- ------------I--- [Ploton to wells, buildings, etc., can be placed on reverse side). plan, showing size of tat, location of system in rel FOR DEPARTMENT"USE ONLY J` fAPPLlATIO` ACCPTED BY---- - ---------------------- ---------------- - . ----- ----------------- REVIEWED BY----- ------------------ ---- --------- ----------- ------------------ DATE-------•- ----------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------- Alterations and/or recommendations:------_ -_. ------- ------------------------ Date FINAL INSPECTION BY:... _. -- - ----------- .J� ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street . i 124 Sycamore Street 205 West 9th Street - � *+ �,. • Stockton,California Lodi,California Manteca,•California Tracy,California F.P.c O. rf 1