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rvK tirrltr UbL: ------ --- --------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --------------- ------------------------- ------------- (Complete in Duplicate) ---- --- This Permit Expires 1 Year From Date Issued Date Issued =L1= 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 LOCATION-SF_ed R� i,.. ---- ------- -- +' - -0��----------------------------------------------- Owner's Name •----- - ------------ -- ------ - Phone-------- ----------------- Address. z ----�-- „ .•------------- --------.---------------..------------------------ Contractor's Name e�rw�_ ' Phone.. Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---L Number of bedrooms -_Number f baths _�_.__- Lot size ---_---_._------------- --------------------------------- Water Supply: Public system ❑ Community system El Private [Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay 0 Adobe ❑ Hardpan {] Previous Application Made: (If yes,date---------------- No ❑ New Construction, Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No eptic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well--- Distance from foundation-----LO-------.- Material-----#-40--gr-4-19-47 No. - - -- -- ----No, of compartments---------?—----------Sizer --�.� Jk"_sLiquid depth--.-V---------------__ V Msposa field: Distance from nearest well__.S.,P--------Distance from foundation----L:?_l-------Distance to nearest lot line-S_l---------- Number of lines-----------1---------------------Length of each line--------JAQ---------------Width of trench----•7-_' ry ____.____.__.-_____-•-- Type of filter material ..-...-Qepth of filter material----../�__.--_.._---Total length-.-.-1.17 ---------------_--_---.---_ r Seep e Pit: Distance to nearest we[1_____/.D0........-Distance from foundation--.-C_-0---__-.-- Distance to nearest lot line---�- ------ fn Number of pits---------1-----------Lining material----s5x-R--------Size: Diameter.-.__�3-.-''. Depth-.. :5_--___------------- Cesspool; Distance from nearest weft----- ------ ---Distance from foundation—_-.. --------.Lining material----_------.----.-.-____-----.---.-- ❑ Size: Diameter--------------------------------------Depth------------------ ---------------------------------Liquid Capacity---------------------------•g Privy: Distance from nearest wel#-------------------------------------------------Distance from nearest building---------------------------- ---- ❑ Distance to nearest lot line---------------------------------- ---------- - --------------------------------------•----------------------------------------- ------------ Remodeling and/or repairing (describe):------ '� -----------•------------------- ------------------------------------------------------•. ---------------------------------- --- ---------------------------------------------------------------------•---------------------- ----------------------------------------------------------------------------------------------•---------------------------------------------------------------------------------------------- ------------------------------- $.. --------------------------------------------------I-------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws4anules and regulations of the San Joaquin Local Health District. (Signed)---------------------- - --------- and/or Contractor) BY: t - - - -- -------- --- -- (Title) (Plot plan, showing size of lot, location of system in r lation to ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---. _ ------------------------------------ DATE-- REVIEWEDBY--------------------------------------------- ------------------------------------ -------------------------------------- DATE BUILDINGPERMIT ISSUED--------------------------------------------------------------•-------------------------------------• DATE_-------------------------- ------------------------------.-- Alterations and/or recommendations:---------------------------------------------- ------------------------------------------------------------------------------- --------------------•------------------------ ---------- ------ -----------------------------------------------------------------------------------•--------------------------- --•---------------------------------- --------------------------------------------------------------------------------- --------------------------------------------------------------------------------•--------------------------------------------------- FINAL INSPECTION BY:. A!• ''" ' Date e�� 'r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi, California Manteca,California Tracy,California F.RC C.