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FOR OFFICE USE: -------------------- -------------- ------------------______________� _...64-F APPLICATION FOR SANITATION PERMIT Permit No. . ------- --------- --- ------------ -------------------- (Complete in-Duplicate) Date Issued I .. ..... ........ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construe# and install the work herein described. This application is made in complia rice with County Ordinance Na. 549. � ,al �' J' - J08 ADDRESS AND O TIO ---------- o ' Owner's Name----- -- - -- ------ -------------- - --------- ------------ -------- -----------.- P h o n e ---3.36-3 Address---------------------------- ------� __' ti. -- ------------- Contractor's Name-------------------------------- - - ---------------------------------------- Phone_`.'r"&kkirz_ Installation will serve: :Residence. Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/ Number of bedrooms ---Number of baths ---I--- Lot size -____________________ Water Supply: 'Public system g Community system ❑ Private ❑ Depth to Water Table S-V ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeA Hardpan ❑ Previous Application Made: (If yes"date.....................) No$_ New Construction: Yes E] 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 Tank: Distance from nearesr well-----------------Distance from foundation------------------- - Material_-_---.-------__-.._-_ -...-_-------__-___-----. ❑��6• No. of compartments--------•-----------------Size-------------------------_--• Luid de h-_._____-- ---.-__..._--Capacity------ - -------------- Disposal Fiekd: Distance from nearest we11.06R1E-Distance from foundation.-, -------- Distance to nearest lot +s. Number of lines'-- -.-- -_- )' -____---Length of each line-3-S7 �_- . Width of trench___ __ _�� g tt-------- �^.--------------------- Type of filter material_- _-- ------Depth of filter material- - __________Total length.....3 -------------------------- Seepage _------_-_--------____Seepage Pit: Distance to nearest welLMtl-!�-._-_Distance f om f undation---------------- to nearest lot line___��.._________ 0 Number of pits-_AQ_W—.C/_)-Lining materiaL_�,__..size: Diameter____-3-3---.._.--Depth.-.,;. .S�----------------- Cesspool: Distance from nearest weil-------------__-Distance from foundation.__--------------- material--------------------------------------OO ❑ Size: Diameter--=-----------------------------------Depth------- -----------------------------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well-------------------------------------------- Distance from nearest building----------------------------------------- Distance --_-----___------- _---_-_____-._._Distance to nearest lot line- --- - - --------------- ---- '------------------------------------- Remodeling and/or repairing (describe):-- --- ---- --d....... ---- e' ' --------------------------- -------------------------- --- --- --------------------k---------._...------------------------------------------------------------------------------•---------------------------------- ------------------------------- "----------------------------- ---------------------------------------•---------e _____••------------------------------------------__;_---------_------------------------------------------------•-------••------------------ I hereby certify that I hd this applic ion and thatthe work will be done in accordance with San Joaquin County ordinances, State"laws, and rgulations of a San q 'n Local Health District. (Signed) -` ----- --- -- - --------- ------.-- (Owner and/or Contractor) -• -- - _l t,�------� ------ - -- --- ---------- Tb tle �reverse A----- ....... --------- (Plot (Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can eplacede). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_7. -s �,--------------------------------------------------------------- DATE--- _0-- - -------------------------- REVIEWEDBY-------------------------------- - -- ------ ----------------------- ---------------•--------------------------------------- DATE-------------- PERMIT,ISSUED--------------------- ------------------------------------- - D TE.-- Alterations and/oir recommendations:—7: --------------------------- --------------------------------------------------------------------------- -------------------------------------------------------------------------"---- ----------------------------------------------- -------------------------------------------------------------- ----------- --- --------------------------------------------------------------------------- --------------------------------------r------------------------- ------------------------------ -- ----- ------------------- ---------------------------------------------------------------------------------------------------------------------- ------------------------------------- --------------- ------------------------------------------------------- -- ----- FINAL INSPECTION BY:..---- �e --------------------------------- Date......... SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street i Stockton,California Lodi,California Manteca,California Tracy,California F.Pmm