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FOR OFFICE USE: ----- �/------- r ---------- -- - ------- -------------------------------------------------- ---- APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------------------- -- -- -------- (Complete in Duplicate) ___- _ ___ This Permit Expires 1 Year From Date Issued Data 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. s S 7 �� 4 (leva- -se JOB ADDRESS/AJN�jD LOCA ION--- ----�---------- ---------------------------------------------------------------------------------------- Owner's Name !/!rte= --------------- Phone -r - -- --- -- ------------------ Address_______� _z- G- _ Contractor's Name f� •------ Phone----------------------------------- Installation will serve: Residence 93' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __I___ Number of bedrooms _f Number of baths _/_____ Lot size .i _ 'X f - _ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet. Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: [If yes,date__--------------_----I No e New Construction: Yes Er"No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No Septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well______-- --Distance from foundation/c2__------------Material-__�!__�_ _____________ No. of compartments_.___..._L-------------Size-_-- AAx_'7----- ---Liquid depth---- -- ---------------Capacity---�'.4 j_a41_ Disposal Field: Distance from nearest well------- -----Distance from foundation__/d_------------Distance to nearest lot line----X-5,_____- �� Number of lines-_9---------------- -----------Length of each line------90_--_--------_--.Width of trench----cif--- ------ Type of filter material_ fs -K_-____Depth of filter material__ld'_"__._-_..___Total length_- ;-- a__________ Seepage Pit: Distance to nearest well-___ ___-------Distance from foundation_/''--------------Distance to nearest lot line____________ Number of pits..74F'/___-------'Lining material=_M.��_.k-------Size: Diameter_.3V------------Deptn____�~----____-__ \i 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____.__.___-__-__________________..___.._. ❑ Distance to nearest lot line- - ---------------------- -------------------------------------------- ------------------------------------------------------------------- Remodelingand/or repairing (describe):------------------------------------- -----------------------------------------------•---------------------------------•-------------------------------- -------------------------------•------------------------------------------------------------------------------------------------------------------ ------------------------------------- ------------------------------ _k - -------------------- -------------------- ---------------- -------------------------------------------------------------------- ----- I,hereby certify that 1 have prepared this applicatioriand.+hat the work will be done in accordance with San Joaquin County ordinances, State laws, an ruffs an re vlatio s of the San Joaquin Local Health District. Cf , . ----- ___. Owner and/or Con+roc+or BY: = (Title) ------------------------------------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _:._ .. ----------- -- ----------C-- ----------------------------------------- DATE-------_-./q- 4�----------------------------------- J REVIEWEDBY------------------------ ----- ------------- -------- -- ---- -------- -tf------------------------------------------- DATE----------------------------------------------------- BUILDING PERMIT ISSUED---------------------------- - ------------ ---- - --------- --------------------- DATE- J� ------------- Alterations and/or recommendations:__--- - - T -- /t �p��---- fC}2]�e/' -- - ----------------------------------------------------r ----- FINAL INSPECTIO?nAy*. Y- - - ------------ Date----- �s`r� `� ----------- -------------------- ---- ------------ JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maze 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California € Tracy,California F.P.c U. {-....� }