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FOR OFFICE USE: APPLICATION FOR .SANITATION PERMIT Permit No. C7.___ ______________ ------------------------------------------------------- (Complete in Duplicate) Date Issued ----------— _----------------_--------___. This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Hea[th 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 "! ....*1 ------------- l--`-� -�i•• / 1 Owner's Name------------------ Phone rl•'OY `�_' Address-----------•-------------- ""- --- Contractor s Name-------------- .r_ ------ ---------- -- Phone------- ------•------•------------- Installation will serve: Residence IS Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other ❑ Number of living units: __l-- Number of bedrooms --�._ Number of baths Lot size _---_____. _� -Y------------ _ Water Supply: Public system ElCommunity system ElPrivate [Depth to Water Table -------- t. 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 ❑ New Construction: Yes ffr No ❑ FHA/VA: Yes No ❑ 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 found. _—Material- ___________________________ No. of compartments---------o4-----------Size -may /f Liquid depth t Capacity.../e`b7! P / Dispos Field: Distance from nearest well Distance from foundation._-�_�_�........Distance to nearest lot lite______ __________ Number of lines_._._____.s _-----_-- --_L__Length of each line- _:�0___.____---,____ Width of trench._ �-�_________---_________ 19 Type of filter materiaL_.�' '. [--Depth of filter material___-.___lr ._____.Total length__----�____________________________ 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 well-----------------Distance from foundation--------------------Lining material--------------.------------_________.� Size: Diameter--------------------------------------Depth ----- ---------------- -----------------Liquid Capacity----------------------- ---gals. Privy: Distance from nearest well___ -_Distance from nearest building._.._ --- -------------------------------- Distance _______ _________ _____ __Distance to nearest lot line------- ---------------------------------------------------------- ------------------------------------------- ------------------------ Q c � t r ` Remodeling and/or repairing (describe):_.X�_ -- ---- --- -- '� ------------------- --------------------------------------------------------------------------------------•--------- ------------------------------------------- --------------------------------------------'---------------------------------•---------------------------------------------------------------- -------------------------------------------••---------------- 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. �-- : =:-----------==-.-4neraOw r.. o 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--------- l -------------------- REVIEWEDBY---------------------------------------- -- ---------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------- -------------------------------------- DATE--------- --------------------- -------------- -------------- Alterations and/or recommendations:------------ -------•-----------------------------•----•----------------------------•-------------------------- ---------•----------------------------- ------------------------------------------------ -------------------------------------------------------------------- - / Date / FINAL INSPECTION SY. ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 340 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California r.P.ca.