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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ... - ------- ------------------------------------------------ 7 ------------------------ ------------------------------- (Complete in Duplicate) --_ - - - - Date Issued .� �--S- ---_- ----- - ----- --- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--------------- �P, --- v A ?-x- 6_440/ We Owner's Name-------- Phone------------------------------------ Address----------- �-- !n - -----`--------------------------------------------------------------�--/----------------------------- Contractor's Name----- ---•----•------------------------------------------------------------------------------------------------ Phone..1_ P Installation will serve: Residence -® Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms _, -- Number of baths ----/. Lot size -----OF --------------------------- Water Supply: Public system ❑ Community system ❑ Private J�g, Depth to Water Table -------- ft. t Character of soil to a depth of 3 feet: Sand Gravel Sand Loam Cla Loam Cla Adobe Hardpan P X ❑ Y ❑ Y ❑ YCD ❑ ❑ Previous Application Made: {If yes,date--.-_--------------I No New Construction: Yes D7,No ❑ FHA/VA: Yes ❑ No ❑ f TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) F Septi Tank: r Distance from nearest well.-��.....Distance from foundation__..- Material......----� - ---- ----- ----------- LV No. of compartments---------- ---- Size----------------------------------Liquid depth----------- -- - --------.Capacity---- --- Disposal Field: Distance from nearest well---3-`'---Distance from foundation----ate.--..----Distance to nearest lot line-------._._ Number of lines--------- _......�P-------Length of each line-------------- r....Width of trench--------P�-,/------------------- f �_ fi Type of filter material-- ------Depth of filter material___--..1--g,----...Total length.-.-....._.-./_,F0----------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- El Number of pits----------------------Lining material-----------------------Size: ----------- Diameter------:---- - Depth--------------------------------- 9' Cesspool: Distance from nearest well-,--------------Distance from foundation--------------------Lining material------------------.-.-..._..---...... ❑ .Size: Diameter.......-•-------------------------------Depth--------------------------------------------------- Liquid Capacity_. --gals. 9 Privy: Distance from nearest Well--_-----------------------�--_---- .---.-----Dis ante from nearest building--------------------- ❑ Distance to nearest lot line------------------ ----------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):----------------- ---------- --------------------------------------------------------- ---------------------------------------------------- -------------------------------------------------- ----------------------------------------------------------•----------------------------------------- -------------------------------------------------------------------- € -------------------------------------------- ------------------------------------------------------------------------------- i - --------------------------------------------------------------------------------------------------------------------------------------------------- j 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. i �n_ ( igned} Fes-- -------------------------------- ------------------------------------------------------------------(Owner and/or Contractor) -------------(Title}------ --- ---------- ---- -- - BY• (Plot plan, showing siie of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - LS---- Ae Ah'--- DATE--------------- � .. 5 ;� --------- REVIEWEDBY - ---------------------- --- ------- --------------------------------------------- DATE - BUILDING PERMIT ISSUED------------- -------------- - ------ --------------- DATE ------------------ - Alterations and/or recommend a+ions----------------------------------- --------------------------------------------------------------------•-----•--•--------------------------------------------- - ------- ------------ ----------------------,-------------------------.....--------------- ---`-------------•----------•------- wa ---------------------------------------- ------------------------------- ----------- ----------------------- - ------------------- ---------------- ----- y 1- (v(o 7I FINAL INSPECTION BY:..... e C_ . _W?4------ - ------------ Date------. - ------- -------------------- - --- ---------------- - SAN JOAQUIN LOCAL HEALTH.DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P-Cfl.