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FOR i FFICE USE: �d ------------ - Permit No. ,�� -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT ------------ / ---------------------------------------- (Complete in Duplicate] Date Issued This Permit Expires 1 Year From Date issued Applicafion 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. 15� JO ADDRESS AND LO• TION--- ice"" '11 6=.V�"'�,3------_------------ --- ---------------- Owner's Name ------------- --------'--- -=---- --------------- - . ---- Phone -- Address Q C-�- ---------------------------•-•---------------- �,-� Phone' s.-3- :2 Contractor's Name----- c G.t___------- ,�P '` Installation will serve: Residence < Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __l- Number of bedrooms _!_ Number of baths ____l_ Lot size --------- __X. --------------- ► Water Supply:, Public system ❑ Community system ❑ Private XDepth to Water Table 4�;dit. 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 All New Construction: Yes1W No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within.200 feet.) ..Distance from foundation _-�-.Materia. -Septic Tank: Distance from nearest well d �,!Pacity�._ - No. of compartments._.______..�--------Size_____,� depth_ _ _ Disposal Field: Distance from nearest well__47q.-----Distance from foundation---1p----------Distance to nearest lot line____ E% Number of lines________- - __ Length of each line-----,`�'s �--------�Nidth of trench_______ ____ _____________ Type of filter material____ ..---Depth of filter material-.---- length_______/Af - 4 Seepage Pit: Distance to nearest well__ --------Distance from fou dation____ Distance.to nearest lot line--- .___... Number of pits------a,2.--------.-Lining material--_____02 _Size: Diameter---3Z....._-------Depth_.._.A --------------- Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material----------------------.________..__- ❑ Size: Diameter----- - ------ ----------------------Depth------------------ ---------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-___________________________.____.__- ----------Distance from nearest building--------______.______________.._--------. h ❑ Distance to nearest lot line- - ----------------- -- ------------------ ----------------------------------------------------- -- ------------------------ Remodelingand/or repairing (describe)---------------------------------------------------------- ------------------------------------------------------------------ ------------------------ --- -------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. i -------------------------------------------- ------ -----------(Owner and/or Contractor) (Signed)----------------------------- By:---------�---L� ------ -----(Title)----- --- ------------ ------- -------- ----------------------- , (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 ll' f9-- --- ------------- ----------------- REVIEWEDBY-------------------------------- -------- -----------------------------------------q---------------------------------------- DATE------------------------------------ ---------------•------- BUILDING PERMIT ISSUED------------------------------------- - $ - - Alterations and/or recommendations j� �i, G •-------------------•------••-------------- ---------- -------------------------------------------------- --------- - -------------------11- ------------------- ------------------------------------------------------------- F€NAL INSPECTION BY:...... -- --------------- --- ---------- Date-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.