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FCR OFFICE USE: LI 006 3 S H 2 tl _-_________________________._______---------- APPLICATION FOR SANITATION PERMIT Permit No. -._.1.1fU --------------------------------------- - ------ (Complete in Duplicate) Date Issued ---- ------ ---------— ----------------- ---------- 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 --�t---- ----- D --- Owner's Name---- ------ Phone------------------------•- - -- - ------ Address-----•-•-- .2...----- -------/,J---------------7__1Z----------- jf_ v }- C40.6 Contractor's Name--------- ----- ----------------------------------------• _-------------------------------------------__ Phone................................... Installation will serve: Residence 4 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j____ Number of bedrooms ----]-- Number of baths ___I__ Lot size ----4�_x_._hM__-__---_____________________ Water Supply: Public system ❑ Community system X Private ❑ Depth to Water Table __-_-_-- ft, Characterof soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay X Adobe 3 Hardpan ❑ Previous Application Made: (If yes,date---------_-------- ) No ❑ New Construction: Yes No ❑ FHA/VA: Yes ❑ No A3 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____ A---------Matlerial.__- 5-,- - ------------------ ---------- [� No. of compartments_-_ r:R--- ----------- wLiquid depth_-_-- Capacity.../_-z6O__-__- D Disposal Field: Distance from nearest well----- --------Distance from foundation----/11 ------Distance to nearest lot line.__S_ ------- Number of lines_____3--_--p-------------___-__Length of each line_/0-^__. _--.4D-_.Width of trench-._s�y"____.__._______-_.__ Type of filter materia€__,1_._e0*7,__Depth of filter material-----MR ----------Total length-------1P__.--_-. -------------------- Seepage Pi : Distance to nearest well-----_----------------Distance from foundation....................Distance to nearest lot line____--_..__-_--.- ❑ Number of pits---------- ___--____Lining material-___ - - _.___-__ Size: Diameter-_-____-_____--__.Depth-------------___--__-__.______-- Cesspool: Distance from nearest well_________________Distance from foundation----------------- -.Lining material-__---_-.____-_--___.____.___________. ❑ Size: Diameter- -- ----------- r_---------------Depth-.------------ -- --------- ------------------Liquid Capacity---------------------------gals. Privy: istance from nearest well_ .__- _ -____ _--__ -_-__Distance from nearest building_-_-___.---------------. -. _---. ❑ Di ance to nearest lot line ------------ Remodeling and/or repairing (describe):-------------- ____.. s -------------------------------------•-------------------------------------------------------------- ------------------------•-------•--------------•------------- ------------•------------- ---- QL ---------------------------------------------------------------•---------------------------•--------------•----------------------------------------------------------------------•---------------------------- --------- --------------------------- --------•- ---------------------------------------------------------------------------------------------------------------------------------------------------------- - I hereby certify that I ve prepared this application and that the work will be done in accordance with San Joaquin County ordina ate I ws, a r s nd regulations of the San Joaquin Local He I District. rwf -._ ---_- _ _- - - -- Owner and/or Contractor (Signe ---------- -- - - - ( / ) BY•--- --- ----(tale)----------------- -------- - ------- - ------------------- (Plot - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ------ - ---- ----------- - DATE - REVIEWED BY--------------------------------- DATE-------------- --- --------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------•-------------------------------------- DATE--------------------------------- -------------------------- Alterations and/or recommendations-------------------------- ------------------- ------------------------------------------------------------------------------------- ------------_----------- ------------ -------------------------------- -----------_------------------------------------------------------- ---------------------------------- --------- ---------------------------------------- ------------------------------------------------------------------------- ---------------------------------------------------- ------------------------------------------------------------------------------------------------------------ ----------------------------------------------------- ------I—--------- ------------------------- ---------------------------- ----------- ---------------------- --------------------------------------- --------•-------- ----------------------------------------------------•------------------------ ----------------------------------------------- ------ ------ ---------------------------- -------------- ------------•- --------------------------- ----------------- ------------------------------------------ FINAL INSPECTION BY:...;�3. -- ---------- Date---- --�`s----S ---------------------------------- 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.CC.