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FOR OFFICE USE: - ------------ -- -------------------------------- APPLICATION -FOrR SANITATION PERMIT Permit No. ........ ..... --------------------------------------------------------- (Complete in Duplicate) Date Issued __-- --Q-- b-S _ - This permit Expires 1 Year From Date Issued w � l 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. 1fl �j ,�J JOB ADDRESS AND CATION---•f D-�_5----��---------. tl�+ �` ..!e��.n--- __ ��c�. - ----&2�!_` c� � � I/ Owner's Name-----/ �=--------r' `_'U3 t t------- ---- Phone Address-------- } --------------------- .__ Contractor's Name__ _-_- = -�!�-----4 — -------- - -------------------------------- Phone----------------------_---------- Installation will serve: Residence o Apartment House ❑ Comm .rcial ❑ Trailer Court ❑ Motel ❑ Other ❑ q Number of living units: I--.--. Number of bedrooms __��. Number of baths I___ Lot size -----7-a X--- ------------------------------------- Water Supply: Public system ❑ Community system ❑ Private V Depth to Water Table -------- 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 ❑ 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 nearest well .. -_=. -___Distance from foundation. . ........... Material..- ... -:_T� .�._f.._6-11--------- No. of compartments---------2---- -- ----Size----2-x=� �/A Liquid depth ---- Capacl#Y � Disposal Field: . Distance from nearest well---- .-. Distance from foundation..../a___-.-_-__.Distance to nearest Iolt line-.-_...... Number of lines------ ------ -----------------Length of each line------ ----- -------Width of trench__:_- _�------------------- ?,,j --- -------- --•-- �J / p Type of filter material__.�.2(r.�-----Depth of filter material....-.��...-___....Total length_.... .-c ....--_.-...... Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line__......--------- ❑ Number of pits-----------------------Lining material----- --- ----------- Size: Diameter-------------- --------Depth------------- ------------------- Cesspool: - ---------------- Cesspool: Distance from nearest well- --------------Distance from foundation--------------------Lining material....---.-----------------------_-.-..-..---. ❑ Size: Diameter- --------------------- -Depth..... ----------------------------------- ------- Liquid Capacity gals. _q ` Privy: Distance from nearest well ----------------- ._...___..Distance from nearest building....................._- ---- -------- r ❑ Distance to nearest lot line------ ------------- - ----- --------------------------------------;------------------------------- Remodeling avid/or repairing (describe)------------------------------------------------------------------------------------------------- -------- ----------------------------------------------- f ----------------------------------- ----------------------------------------------------•-------------------------------- I ----------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Jaaguin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) _ --- ------ - ........ -------------------------------- ----- --------------------- -- _...............(Owner and/or Contractor; BY� `---- ,--��'L-� ?.�f �C1- ---------------------------- (Title) - (Plot plan, o+�ing size of lot, location of system in relati a wells, buildings, etc., can be placed on reverse side). F R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- _-- ----------------- DATE-- �J 7---�`- ------------- t ------------- - ------------------ ----------- REVIEWED BY--------------------------------------------- ---- --------------- -------------------------------------- ------------- ----- -- -- ------------------- - DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------- - ------- --------------- ----------------;DA•TE--------------------------------- ------------------------ -- Alterations and/or recommendations:--------------------------------------- - ------------------------ -------------------------•----------------------------------- ---------------•----------- I FINAL INSPECTION BY:- -- C'czy --- Date-------- ----�-- --- -------- - ----------------------------- ((( SIN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Avo. 300 West Oak Street 124 Sycamore Street 205 West 9th Street } Stockton,California Lodi,California Manteca,California Tracy,California i F.P.CC.