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FOR OFFICE USE: L /A-0 1�2_ ----------------------------------------------- ------- APPLICATION FOR SANITATION PERMIT Permit No. 40r 1 y2_.J... ----------------------------------------------------- Duplicate)-- (Complete in - Date Issued /c.�/1-�,5 -----------------------------------------------------. 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. ........A ....... ............ ------------- JOB ADDRESS AND LOC TION .........le Owner's Name------------------ -- -- ----- ----- ---------------------- Phone----------=----•-_---- - -- ------------�-------------- --- ---------------- -------------- Address � Q - f� ? Contractor's Name =d �'----------------------------------------------------------------------------------------- - Phone Installation will serve: Residence $ Apartment House [-] Commercial E] Trailer Court ❑ Motel E] Other ❑ Number of living units: __1--- Number of bedrooms 1,_-_ Number of baths -1----- Lot size ___A&_4'--�1/.110_____________________________ Water Supply: Public system ❑ Community system IR/Private ❑ 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 [g�" New Construction: Yes R-*'_No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) //� cc77 -�.� ��-- Septic Tank: Distance from nearest well-1-4 /Distance from found�tion_�_�_.1_-----------Material -�-�s No. of compartments------ --..- ---Size-_��__--f_X__Z_1_.---Liquid depth_.,f._ �r---------Capacity);4 Disposal Field: Distance from nearest well-jQAn_?�Distance from foundation-— ----------Distance to nearest lot I�ne« .__-_._.._. Number of lines------- Length of each line_, C'__ _.Width of trench___ ----_--_--_-_--_-_--_--- j Type of filter matenal_14-./L42e:�Depth of filter material_____ _��------Total `ength-_-__�----�_-______-__-_-_ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line_________________ ❑ Number of pits---------------.------Lining material-------------- --------Size: Diameter-----------------------Depth______-____-_---------------__ Q\. Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material---------------.------------_________ N ❑ Size: Diameter--------------------- --Depth---------------------------------------------------Liquid Capacity_--------------------------gals. Privy: Distance from nearest well_____________ -----------------Distance from nearest building----------------------------------........ ❑ Distance to nearest lot line-------------- --------------- ----- - --- ----------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):- ---------- - --------------------------------------------- .. -------------------------------------------•------------- -------------•-----------------•------------------------------------------ --- - -- ---- ------------------- -------------------------------------------------------------------------=----------------------------------------------------------------------------------------- --- - ------ ------•------------------ ---- -------- ------------------------------------------------------------------------------------------------------------------------------------ 1 ------------ -�-�---- 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, ndprules and regulations f the San Joaquin Local Health District. (Signed)---------------------G-�J-l. u�- --= --------------------------- ----------------------------------(Owner and/or Contractor) BY: ----r-------------- - (Title) - ---------------- - 0 (Plot plan, showing size of lot, Iodation of system in relation to wefts, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------------- ------------------------------------------------------------------------------- DATE-------------------------------------------------------- REVIEWEDBY------------------------------ --------------------------------------------------------------- -------------------------- DATE------ --------------------------------------------------- \ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE----------------------------- ------------------------------- Alterationsand/or recommendations---------------------- ------ ------------__-------------------------------------------------------------------------------------------------------------- --------------- -------------------------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------- ------------------------------------------------------ ----------------------------------------------------------------------- ------------------------------------------------------------------------------------------- ---------------------------------------------------- -- C-- --- ---%---------------------------------------------------------------------------------------------------------------------------------------------------------- ------ FINAL INSPECTION BY:..-..L;5 XDate l - 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.CO.