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FOROFFICE USE: - ------------------=------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..��' �� ---------------- ------------ -------- (Complete in Duplicate) -------------------------------- This permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permiitt�t,$construct and install 1he work herein described. This application is made in compliance with County Ordinance No. 549. f Q�Y�' 1 }a QCH tV Cd T` 0F� JOB ADDRESS AND LOCATION__C eq ?i T A� ! T'e V 1LS4,1'N,D P-P Al c_VZPF f.. ...._.-Y--- - --------- ----------�------/✓----------- Owner's Name------ M N�"�E --------' d-� Address---------------�• '`''4 Contractor's Name------- �2.T Phone__ olq------ 3_1 2 Installation will serve: Residence % Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _A--- Number of bedrooms _2--_ Number of baths Lot size ----------I---------P:}_ °% f_t__G�____________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _`90ft. 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 ❑ 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 foundation--------------------Material---------------.---------.---_____._...---_--__. ❑ No. of compartments-------------------- ----Size--------------------------------Liquid depth--------------- ----------Capacity----------------------- Disposal Field: Distance from nearest well.....: .0 __--Distance from foundation-__._}_P-_-------Distance to nearest lot line_____-_!____.. CT1STII`lG Number of lines------------- -----_Length of each line_______-4,S____ _______Width of french----------- j f}'D D Type of filter material-S_e_Rccr1C__Depth of filter material----------tl.__------Total length-----------------------r q%:r___.__-. 1� 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 to nearest lot line----------------- l Remodeling and/or repairing (describe):-------A--A-�------O -------�7C.14_T_�.�s�--------=5 `�5+ ---------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------- 1---------------------------------------------------------------------------------- ------------------------ ------------ ---------------------------------------------------------------------------------------------------------------------------------------•--------------------------------- ----- ---- - - 1 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. r y (Signed)----------- -------------- --• - --------- ------- ------------------------------ (Owner and/or Contractor) By:------------- �9------�-a-4^r�=--- R (Title)------------------- -------------------- -------- (Plot plan, showing size of lot, location of systemin relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ------------------------------------ - DATE----------------------- ---------------------------------- - --------------------------------- REVIEWED BY ....... ------------------------------ DATE......— BUILDING PERMIT ISSUED----------------------------------------------------------------- ------ - ..... '__ DATE. .------------------ C Alterations and/or recommendations------- ------- - - ---------------------------------------•---------------------------••-----•------ -----------------------------I- ------------------ ------ ---- --------------- --------------------- ---- -- -- ------------------- ------ ------ --------- FINAL INSPECTION BY:---- -- ----------------- 1/` _ Date t SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:eiton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C L3.