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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ._.�...-:/---•-•_--.•- ------------------ i --- ---------------------------------- (Complete n Duplicate) Date issued .R ----------- This permit Expires 1 Year From Date Issued - ------------------------_-.- -:-.--------.- 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____- �4' __ --------------•--------•---- p ... Owner's Name-------•---•+ • ---�-- -•----------------------- ---------------------------------------------------- Address-------------__------- •-•-----------------------------------------------Address-------------•-••------• 1, ', y�.� tis�� Contractor's Name.. ''..- r!-, 40L ��'S- .--.-. Phone 7 ---------------- _A4 -- ! dP7 Installation will serve: 'Residence Apartment House ❑ Commercial ❑ . Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _��Coimmunity mber of bedrooms _-- Number of baths __/.-- Lot size -------- _ _ _ _la- ------------------------- Water Su I Public 's stem s stem Private De th to Water Table !po ft.PP Y� Y Y ❑ ❑ P Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe Ig Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ Nov_ 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---MWKL. _Distance from foundation---Ia-/------Material_--------- 'rJ-__-- No. of compartments Size- __.-_--- --- ---- — Disposal Field: Distance from nearest well-Nei-.-Distance from foundation-.-__/4 -'---.Distance to nearest lot line----_�'-� q Number of lines---.------�--------------------- Length of each line----,JF__12---.__--_----Width,of trench-------- _- -!�-----------_ Type of filter material._ Depth of filter material.--_-1_g_`►----_.-Total length------- ----------------------- Seepage Pit: Distance to nearesf:well--t--\a%A-- `_:_Distance from foundation---1__.D__--.__--.Distance to nearest lot line_... --_-.- Nuinber of pits--_ (---------------Lining' material--- Size: Diameter-_.-._-.--_- .. 1 3- �-��----Depth-------••----------------------• Cesspool: Distance from nearest well__-_----._..-.--Distance from foundation--------------------Lining material----_.-----__..----._-_------------- ❑ Size: Diameter--:---- ---z--}--------- ----------Depth-------------;---- ---------- ----------------------Liquid Capacity_--------_-•-------------g � Privy: Distance from nearest well------------------------------------------------------- ---.....Distance from nearest building-------------------------- __------__----- ❑ Distance to nearest lot line---- -----------------------------------•--------------------------------------•----------•-•-------------- -------------------------- Remodeling and/or repairing (describe)----- -------- - ------ ---- -----------------------------------------------•------------------------ ------------4)-------)-------------------__--------------------m------------------------------------------------------------------- 3 : 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, and rules and regulations of the San Joaquin Local Health District. (Signed) - T� ...... - ---- - ---------•--------------------------------- or Contractor) I'f Title---------------------•------------------------------------------ 3 BY:------------------------------------------------------------------------------------- -- ( ) (Plot plan, showing size of lot, location of system in relation to ells, building etc., can be placed on reverse side). 1 FOR DEPARTMENT USE ONLY APPLICATION ACC a ` - EPTED BY :_- z'� "� DATE REVIEWED BY-� ---• - = '` 6� , TE BUILDINGPERMIT IS UED-------•-• --•--------------------------------------------------------------------------------------- DA•TE.-------------------------------------------- Alterationsand/or recommendations- ---------------------=---------•------------------------------------------------------- -----=---•--•---------------------•--------••--------- ---------- ----------------- ............... .z FINAL INSPECTION BYc:.... � ---------------------Date _ ? r ------ •---------- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 1 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California 1 Lodi,California Manteca,California Tracy,California E9.9 arvisEO a-s9 r.P.CO.2M 6-50