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FOR,OFFICti USE: ------------------ ------------------------------------ ' -------------- -- --------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. -------------------- ------------------------------- (Complete in Duplicate) Date Issued ---------------------- -------------------------------- This Permit Expires 1Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work her n de ,gibed. This application is madeET ompliance with County Ordinance No. 549. JOB ADDRESS AND LI0 -----....li- +-�-f1-��t r'----- =------ FZD__.. ----- ------a-'` : __17.f._.� .._1 1_h.1 1 Owner's Name ✓ i/ �]1 ..:4�,�_LnF8----------��-l: 1v1 2L�----=--------------------------- Phone------------------------------------ 3-f.: ---------------------------------_- Address------------>t_a-----r ��== 1 (:-.k=� ' ContractorsName-------- --------------------------------------------------------------------------------------------------------- Phone----------------------------------- Installation will serve: Residence El'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /----- Number of bedrooms,-'> Number of baths -_/- __ Lot size --__._-/0Q_-_ ----_�--0�--------------- Water Supply: Public system ❑ Community system [❑ Private [a-'bepth to Water Table _- if. Character of soil to a depth of 3 feet: Sand p"Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------I No [9--'New Construction: Yes ❑ No ]/FFiA/VA: Yes ❑ No 0r— _ TYPE OF INSTALLATION AND �SPECIW.ATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well___5_�2--_Distance from foundation-----0--------Material Q ---__------. ROlaf - No. of compartments-------Z--- -----------Size_ `'_%_X--_--57__Liquid depth____ __. ___ r Capacity-__��'� i a 1 Field:• Distance from nearest well-_ E��__._.Distance from foundation_-_- IV---------Distance to nearest lot line------ JUNG Number of lines__________ ______________________Length of each line---.---- .,`7 -__-_.Width of trench--------- Ez_��____�--_---- Type of filter material-__- �1�.- --Depth of filter material-_-_4�_-_-.._--.Total length------------------- --------------- N 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--.-_----_-______.____.._.____._. „r ID Size: Diameter---------------------- ------ -------Depth----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---._-__-__.-__-_-_-_-----.._-..-_----. Z ❑ Distance to nearest lot lire----------- •---- ------------------- ------------------------------------------------------------------------ -15 Remodelingand/or repairing (describe) ------------------------------------------•------------------- --------------------•---------------------------------- ---------------------------•-•--------------------------------•------------------------------------------------------------------------------------ ----------- --------- ----------------------------------------------------9. ------------------------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------------------------------.------- ----------------- ----------------------- --------------- ------------------------------------------------------------•---------------------------------------------------------------------------------------------------------------------- -------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S ateJrvs;.ancu es and regulations of the San Joaquin Local Health District. {Signed �, ,___ L ._ Qf/ Owner and/or Contractor ) ------- ------------------------ ----------------------------- ----( ) • f? - � ._ -- --------- -------------- [Tale)----- ---------------- (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 -F APPLICATION ACCEPTED BY--- �s --------------------------------------------------------------------- DATE-------- 1Q�. 5 --------------- REVIEWEDBY------------------------------------ ---------------------------------------------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ Aiterationsand/or recommendations:--------------------- -------------------------------------------------------------------------------------------------- ------------------------------------- ---------- -------------------------------------- --- ---------------------- ------------------------------------- -------------------------------------------------------•------------------- --------------------------- ------- ------- -------------- ------- --------------------------- .......................... ------------------------ -- ---- FINAL IN5PECTIdN—B-Y--.. ---- Fj Date-------- ----- �7 - 7>j.____....._..____----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 724 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. ftL_CMZL__