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/FOR OFFICE USE: -------------------- •-r --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -------------------------------------------------------- (Complete in Duplicate) g This Permit Expires 1 Year From Date Issued Date Issued This i lien is r made in to lienee with C nt Ordinance No. Sf r a Cr /SAO rO� Application is hereby made to the San Joaquin Local Healfh District or a permit to construct and install the work herein described. application p Y 4 . f'lbd' JOB ADDRESS AND"CATN______ - ------ - ----- ---------•• ----------- Owner's Names ----- ------- Phone_y ----- - --------•--,----------- Address---s .,7___.___ -?. �._._ _ y .. .. ..... . .. ..... ............. Contractor's Name---- ____ ------------------------------------------ Phone.�� 3,- V�Z___ ' - - - ------•----------- - ------ ---------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Curt ❑ Motel ElOther Number of living units: -------- Number of bedrooms -------- Number of bathsAsize ____- 4____-> P' /_____________________ Water Supply: Public system 9 Community system ❑ Private ❑ .Depth to Water Table �/4 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.) L� ,L Septic Tank: Distance from nearest well.L�K�_Distance from foundation__AQ....--.... _Material- ----------------------------------_____..... �[ No. of compartments____v— _ __Size_��_�_��-Sx?________Liquid depth___!` Capacity_ _a7Q� .� - f Disposal Field: Distance from nearest well Distance from foundation--_Z ---------Distance to nearest lot line__-.- r!7sc. T umber of lines___.__._ ..._. ---_-__--Length of each line_ _ -7 S - -Width of trench-__.--,;- __ .. N I_ ype of filter materialsCJa1 _._._Depth of filter material....1_�---------_Total length--------------------� _ ________ Seepage Pit: Distance to nearest well4N �.___Distance fr m fo ndation___, l�_---___.Distance to nearest lot lme__s.___ ' 3 ._._. De to �Z Humber of pits.--___o--___________Lining material_ -_Size: Diameter___- p Cesspool: Distance from nearest weii-----------------Distance from foundation___-----------------Lining material------------------------------------- El Size: Diameter--------------------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building._..--___..-----.--_-----__----.__-- ❑ Distance to nearest lot line--------------------------------------------------------------------------------------------------------------------------------------------- Remodeling 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, fe laws, and rul s and regulations of the San Joaquin Local Health District. (Signed)------------ 44- - / - --------- ------(Owner and/or Contractor) 77 By:------------------- -••---- --------- ------(Title)-- -- (Plot plan, showing size of lot, location of system i relation to wells, buildings, etc., can be placed gA reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- �� DATE / �( `7 ---------------- REVIEWEDBY------------ --------------------------- - - ----- -------------------------------------------------------------------------- DATE----------------------------------------------------------- BUILDING PERMIT ISSUEDL p .1 DATE. ( Alterations and/or recommendations---------- �-- ------------------------------------------------------------------------------------------------------------------------------------------------- ------------------••------------------------------------------------------- -------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------- --------------------------- --------- FINAL INSPECTION BY:.------. .. - C1----------------------------------- Date--------- ,le------ ---- - --_ 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.P,C❑.