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FOR OFFICE USE: ----------------------- -------------------------- - ----------------------- -------------- - ---------- APPLICATION FOR SANITATION PERMIT Permit No. --- ---- -- __��-----•-�-r-L- t._ -------- ----- (Complete p -- ------ ---------- ----==--- - Cin Duplicate) Date Issued 7 - - ---------- -- i----------------- - ---- - This Permit Expires 1 Year From Date Issued - Application is hereby made to the San Joaquin Local Health District for a permit to cons ruct and install the work herein described. This application is made in compliance with County Ordinanc No. 549. _ ------ -------- JOB ADDRESS LOCk� ION. •- - - ------ -- ----------------- ------------------ .. �: 7.943 i-------------------- -------------- Phone_.. Owner's Name ----- ----------------(I Address _P-------- ----•-------------------------------------------------•-•-------------•-------------•--------------------------------------- ------.. E - ---- - ----- ----------- Contractor's Name----- --•=-� .r� -- --------- ❑ ❑ one_ � Installation will serve: Residence ['—Apartment House ❑ Commercial ❑ Trailer Court ❑ Mo#el Other of living units: 2-- Number of baths __I____ Lot size __. �' �— - --..-- Number of bedrooms _ // ----•--------------------------------- NumberWater Supply: Public system ❑ Community system ❑ Privateepth to Water Table -42_ _ 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------ - -__.__ )-No New Construction: Yes �No E] FHA/VA: Yes �No ❑ TYPE OF. INSTALLATION`AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` f / ,.. Septic "nk: Distance from nearest well---4: __..._Distance fromr,foundation__--__r1------.-M4tePial-..- _c�'' .---------_________....__... ... e ; No. of compartments-- -/ ---------- Size Liquid depth apacty i f • i Disposal Field: Distance from nearest well Distance from /S Distance to nearest lot line_�__....._ Number of,lines______.� -----------------------Length of each line--- -r Width of trench.._._.�_ --•- ---------_---- e Type of filter material__' Cz4_ ..___Depth of filter rnateriaL___ __ ----------- a � otal length---------�-�-a--------------------�---- �' Seepage Pit: Distance to nearest well.f-C��?.___----Distance from foundation___f.,2^_______.Distance to nearest lot line�_._�_.___ Number of pits.---. ..-----------Lining material_' G� ---Size: Diameter--- -11 Depth_..---- ------------------ �G Cesspool: Distance from nearest well-----------------Distance from foundation_._'_- ------------Lining material-------------------._-_._..__-9.___ 171Size: Diameter----- ----- -------- ---------------Depth-----------------F "' Liqu d Capacity --- als. f1*11'1t Privy: Distance from nearest well_________________-r------------------------- ---Distance':from nearest building------------------------------------------ E y Distanceto nearest lot line-- ------------------------- ------------------------------------------------ -------------- - ------------- -------- TV Remodeling and/or repairing (describe)--------------------- -------------- ------------- - ------------------------------------•-------------------------------------------------------• I. - - ' ------------------------------------------------------ F `-----'------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---------- ------- r _____ __ __ _ _______ __ _________ ____________________________________________________________________________________________________________________________.____-__________.____________...__._____-_-___.____._-- 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, rule and re ulati ns of th San Joaquin Local Health District. (Owner ani/or Contractor) {Signed] --------------------------- - ry Title (Plot plan, showing size of [ot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. T FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED'BY ----------------------- DATE---- 7 hhP_ l REVIEWEDBY----- ----------------------------------------------------------------------- ------- -------------------------------------- DATE------------•------------------------•---------------------- I BUILDINGPERMIT ISSUED:------------------------------------------------------------------------------------- --------------- DATE--- ----------------------- --------------------:---------- J Alterations and/or recommendations------------------ ------------------ ----- ------ ------------------------------------------------------------------------•------------------------------ I --------------------------------------- ------------- --- . -------------------------------------------------------------- ----•-----------.- ------------------------------------------------------------------------------ ------------- -------------- ------- ----------------- ------------- ---------------- ------ r ' - _ ---------------- FINAL INSPECTION BY:.. ----------------- Date_-- •f ...... -------------------------- r SAN JOAQUIN LOCAL HEALTH DISTRICT 'I 1401 E.Hatelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California 1