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FOR OFFICE USE: -74y-=--------- --------- �A -- APPLICATION FOR SANITATION PERMIT Permit No. .....��---1`-=�- - ----------------- (Complete in Duplicate) -------------------------- :This Permit Expires i Year From Date Issued Date Issued+-__9/7/, 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 L CATION._.__�?___7�?47 ______--_--_ ------------------ -- - -------------•------------------------------------------------------------------ Owner's Name_' ` - ----•••--------•--•---•---------•-----------•------------------ - ------------------ - - -- - ------ Phone---"-----------------------•-------- 1� Address--1-,?' :7L Q-a. - " Contractor's Name L.S-----••-----•------------------------------------- - --------------------------- ---------------- Phone------ •----•---•-------• --------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I------ Number of bedrooms __Number of baths ---L Lot size ____________________________________________________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table .W/.A ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (1f yes, date----_---- ----------) No e New Construction: Yes ❑ No f�J'FHA/VA: Yes ❑ No E�� TYPE OF INSTALLATION AND SPECIFICATIONS: 4 t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r � . Sept'c .f Distance from nearest well-----------------Distance from foundation-----------t.____.Material__________ _____________________________________ 7 No. of compartments----- --------- ----------Size-------------------- ---- ------Liquid depth---- ---- ----------Capacity F' l Distance from nearest well-_- ------Distance from foundation__6---t_--_._-Distance to nearest lot line-C6�_�_____• t Number of lines------ __-�® g _f - Len th of each line___ �--.___-_____�-._.Width of trench ._�__."_______________ Type of filter material____ r (%_____Depth of filter material----�_K'.'_..__.__Total length____---�p-P.----.----____-.----.__ 4 Seepage Pit: Distance to nearest well._._—----------Distance om fou dation___lp_�_____'_._.Distance to nearest lot line__________ �- Number of pits/------------ ---Lining material--__-- -Size: Diameter._--_--��-3_`'__--Depth--------;.Z--A—.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------------------------------- __ - -__ Remodeling and/or repairing (describe):-------------.-------- i } ; -t d i ---------------•-----------------•----------------------------------------- --------------------- 1 i ------------------------------------------------------------------------ ---------------------------------•----------- -----------------I----------------L---------------------------------------------------------- ------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat aws, an�sd ations of the San Joaquin Local Health District. (Signed) --------------------------------------------- --------- -----------------------------------------------------(Owner and/or Contractor) By:-------------------------------------------------------------------------------------- (Title) ------------------------------- ---- - .....--------- ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- C F ------------------------------------------------------- - --------- DATE_---- = = - - ------------------------------- REVIEWEDBY------------------------------------------- - ---- ----------------------------------------------}--------•------------------ DATE----- - ------------- BUILDING PERMIT ISSUED-----•------------------------------------------------ ----------------- It---------"----------------- DATE-----------------------`-------- Alterations and/or recommendation :------------------- ----�_---------- - ------------•-------'. _- '"--------------------------------------- 7� ` .- -�------------------------------ -------------------------------------------------------- -- ----------------------------------------------------------------------- -------- --- ----------------------------------------------------------------•---------------------------------------------------------------------- -------------------------- -- ------------------------------- ------------------------- - ---------------------"------------------------------------------------------------------------------------------- -------------- h FINAL INSPECTION BY:_.------r- --------------------- Date -�5� --------- --------- ---I------------------------------ --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hareellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California E i