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{"•' OR OFFICE USE:. f .11J__ APPLICATION FOR 'SANITATION PERMIT Permit No. .r�>,� ---------------- --------- ------- -------- (Complete in Duplicate) t Date Issued ._7_ __-4� -------------------------------------------------------__. 1 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.)..------�A �--------- = r Owner's Name--------- -- ----------LIQ ---------- --- `-Phone-----•-- -------- - -------------------------------- --------------------------- Address--.- Y U.... Contractor's Name------- ----- Phone -1- /yY Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_/_. Number of bedrooms _- - Number of baths J--- Lot size ---- - - - - L-U-------------------------- ! 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 0 Clay Loam ❑ Clay ❑ Adobe [Hardpan E] Previous Application Made: (If yes,date-.-----------------) No ❑ New Construction: Yes [P-11No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well Distance from foundation--1---------.Material_. . ----------------------------------_--. No. of compartments__*___,_o� ..-_..----Size-- - ----.---Liquid depth--- ------------------Capacity--�4�� Disposal ield: Distance from nearest wel .-Distance i Length of from line at��-----------Distance to nearest lot line--�...O0... Number of lines--------/--------------- -------- - ---" -Width of trench---.--�5�-------------- Type of filter material--- Depth of filter material_--`,_/8.--------Total length-------------------- Q-----------_-- Seepage Pit: Distance to nearest well ----Distan m foundation)/�-----_---.Distance to nearest lot Number of pits----- ------------Lining Diameter__-3 3_-��-__._____Depth-...-. ------------------- Cesspool: ------..-------.-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-- ------------------------------------------------ ------------------------------------------------------------------------.......... Remodeling and/or repairing (describe)=---------------------------•---- ------------------ -------------------------------------------•-------------------------------------------------------- i I -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------ ------------------------ ----------- -------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St to laws, and rules and regulations of the San Joaquin Local Health District. - t (Signed)--- ------- ----------------- - -- -- ------------ -------------- --- (Owner artd/or Contractor) -- - - . Title - .. (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be p ced on reverse side]. 1 FOR DEPARTMENT USE ONLY t - - - APPLICATION ACCEPTED BY-------------- --- ---------------------1 -- - ------------------------ ------------------------------------ DATE �---------------------------- REVIEWEDBY- ----- -----------------------------------------------------------------:_: DATE_.----------- -------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alationsa /or rec mmendations:---------- ---------------------------------=---------------------------------- -------------------------------------------------------------------•--------- -- ------- --- ------- - --------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:--------- ��_7_---------- ---- --------------------- Date- --------;?7. - -��- ------------------ ------- ---------- SAN JOAQUIN LOCAL HEALTH DISTRICT t 1601 E.Ha=elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California O-