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FOR OFFICE USE: ----------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No.f��.__......__ . - f� ------------=- ---------------_....---- ----- ---------------- --------------- --- --- ExpiresP..e•in r F icatel «e Issued oo,lvw Date Issued om et ' ---.-- This Permit 1 Year From Dat 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 AN OCATION =`` / i� -------- •_ .._ Z.yr v1---------- - ----------------- Owner's Name :- ��' -eb-----------•------------- ------ ------=---------------- ----------------------- Phone------------------------------------ Address 44-19A37------- A 4erx 4--- --------- ------ Q 10, Contractor's Name--- - - ------------------ ------- -------------------------- ------- ------- ----------------------------------------------- Phone------ -----.-------............... y Installation will serve: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _l.__ Number of bedrooms ---L Number of baths-1------ Lot size _t --�.:__3,/6 Water Supply: Public system ❑ Community system ❑ Private JV Depth;to Water Table k_'5_ ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ;N� Clay ❑ Adobe ❑ Hardpan Previous Application Made: (If yes,date.............._. . I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ,(No septic-tank or.cesspool permitted,i f public-sewer_is availablewithin;20Q feet.} Septic Tank: Distance from nearest well Sa. Distance from foundation--f q--. - Material -. -------- - --------- No. of compartments------Z-----------..._ Size : __'_- ---.__'_Liquid depth------ . .._. Capacity Disposal Field: Distance from nearest well._,L —0___ -Distance from foundation----/_(!".----..Distance to nearest lot line__S"-__-.__. Number of lines----------/..._.____----------Length of each line.. _.__ ` _.....______.Width of trench----a'.Y_"___________________ T e of filter material-_ `, YP �- �-..------Depth of filter material-----�--Q---,------Total length---�Q----------------•------------- Seepage Pit: Distance to nearest well.__/----....___Distance from foundation_-/._n----------Distance to nearest lot line__j�___-___-- l Number of its--- 1 Depth - _Linin material_____ __ ____ _______ Size: Diameter_-.._ _ _ p ----------- 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__.._______________-_-__.________....___- j . ❑ Distance to nearest lot line -------------------------------- -------- ,,R-<modeling and/or repairing (describe):--- ----- -----____---------------------------------------------- I hereby certify that i have prepared this application and that the work will be done in accordance with San.Joaquin County ordinances tate laws, and rules nd reg tions of the San Joaquin Local Health District. {Signed} '� --- . - ------ ----------------------- ----- ------------- ---------------------(Owner and/or Contractor) BY: --------------------------------- ---------- ------------------------------•---- ----------�------------(Title)-------------- -- -------- ----------------- _ [Plot plan,showing size of Iofi, Eocation of system in relation to wells, buildings,'etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ---- --- -------------------------------------- DATE-- REVIEWED ATE-REVIEWED BY--------------------------------------------- ---- ------- -------•----------- ------ DATE---------------- ; BUILDING PERMIT ISSUED-------- -- -------------- --------------------------- ------------------------ I------------- DATE----------------------------------- Alterations and/or recommendations:---------------------- - ---------- -- -- ----- ----------- -------------------------- ---- Ili - - �--- -------- � '---------- ��'--------- = -- ------------------F--------------- -- -- ------------------------------------ a E� ----• -- ------- -- ---- -- ' �_.. 6 ' FINAL INSPECTION BY:-�� bate - -�- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 F.Hazelton Ave. 300 West oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi. California--, Manteca,California Tracy,California F.H.92M 1-67 Vanguard Press �/