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FOR OFFICE USE: --------------------------------------------------------- -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. �� _______ --------------------------------------------------------- (Complete in Duplicate) Date Issued __�___1--�/ ________________________________________________________ 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 iinstall the we k he escrib This application is made in compliance with County Orglinance No. 549. y JOB ADDRESS AND LOCATION_.- f ...... ,.- ---- Address - Owner's Nam .... Phone....---•-------•------._ Address------- ----------- � �''. ---- ell. � Contractors Name__ : .... ..__. Phon - -------�--�-- ---- -�.q ' e,� f Installation will serve: Residence artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 'J �., le f Number of living units: ____ Number of bedrooms--. Number baths _ Lot size{i7r7cs__-.__ __ _______________________ _ 0Water Supply: Public system ❑ Community sys em ❑ Private Depth to Water Table/p_ ft. Character of soil to a depth of 3 feet: Sand a Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [] Hardpan ❑ Previous'Application Made: (If yes'date---------------------) NoAr",New Construction: Yes No ❑ FHA/VA: Yes Z"No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank'or cesspool permitted if public sewer is available within 200 feet. Septic Distance from nearest,well.. .__. -Distance from""oun a hOp+�___ ____.Mat al____ '_"_"' ----- ..No. of compartments._ ________Size_ p -K,r�C7_Liquid depth__4CO._.`.._---_-Capacity_4 DisposalFi ld: f Distance from nearest well- .Distance from founda ion_/Q Desistance to nearest lot line-----.-_------- ' Number of lines_____-_-____ ___ Length of each line __.__ 4& �v Width of trench----- _��______.________ 1 +' Type of filter material__ ____Depth of filter materiaL �'_`�____.--_Total length '-�_______I1q.5_� �' - 4 Seepage Pit: Distance to nearest well_______________ ______Distance from foundation___.______.._-_____.Distance to nearest lot line____:_________.-_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter_--------------------Depth--------------------------------- Cesspool: Distance from nearest weil---_-------------Distance from foundation--------------------Lining material,_----_______________________________. ❑ Size: Diameter----- --------------------- --------IDepth----------------------------------------------------Liquid Capacity----------------------------gals. �r Privy: Distance from nearest well-------------- -------------------------------Distance from nearest building____--____________________.______.._. ❑ Distance to nearest lot line----------------- ------------------------------------------------------ ----------- --s------------------------------------------------------ -------------------•-----•------------------------------- -------- Remodeling and/or repairing (describe): FFt - 1L--7---Y�t�------------------•---------------------------------•----•--..---- r i s ____ \�s I hereby certify that,;_have preparegd this application and that the work will be done in accordance with San Joaquin County ordinanceX-1 , la s, adrusandre ulations of the San .loo uin Lacal Health District.---I--------- = pkfo -------- ----------------------------------------------------------Si ned _ tractor) [ g � -- --------------------•------------------------- -- - ----------------------- Title.................................................. (� -- --- r�on [Plot plan, showing size of lot, location of system in re! wells, bu'dings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY I t ` --- - -- -"° :. 4 - ---------------- DATE----- j REVIEWEDBY--------------------------------------------- --------------------•------------------------------------"-------------------- DATE---•-----------------------------------•----.... BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------1------------------- DATE----------------------------------------------.-............. Alterations and/or recommendations------- ------------------------- --- ----------------------------------------------------------•--•-=----••-------------•-••---------- ---------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------- ----- � d -------------•- -----•---------------------------•-•----------- ---- --------------- -----------------------------------------------------------------•------- t ------------------ -- ---- ------------------ -----a, ------------------------------------------------------------------------------------ ---------------------------------- FINAL INSPECTf Date----- - -- . _ - %` �p ------6_13-------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak street 124 Sycamore Street 205 West 91h Street t Stockton,California Lodi,California Wionteca,California Tracy,California en-9 REV16to 6.69 F.PX0,YM 6.60