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FOR OFFICE ULE: ------------------------------------- ------------------ ------------ ------------------;-------- ---------------- ---------------------.-_--------------------_-_.___.-------___.___-___ 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 permit to construct and install the work herein described. This application is made A mpliance with County Ordinance No. 549. M —meq JOB ADDRESS AND LOION__ �_D j� �}T�R4-p------- � ---1%_7 -- � ��J G_ Owner's Name _ 44 hWl _. -----.- ---- ---- ------------- Phone-,------------------------------•--- Address-.---------- Contractor's Name---(9 rq-FFP-------------------------------------------------------------------------------------------------- ---------------- Phone------ ---------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: t----- Number of bedrooms::�-7 Number of baths j____ Lot size _,/9____l4Cg__�- - - Water Supply: Public system ❑ Community sy em ElPrivate EDepth to Water Table _ _ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobes❑• Hardpan ❑ Previous Application Made: {If yes,date--------- ----------) No e New Construction: Yes [�N•o ❑ FHA/VA!"itY`es ❑ No [� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �j Septic Ta Distance from nearest weil_____a----Distance�/from foundation__-_,[ _...____.Materi i __REt)_WoPp._-r No. of com --___ partments-------- ------.-.--Size_ 1_aX_ ------Liquid depth__.- Z�......Capacifiy_,1f3 ---: Disposal eld: Distance from nearest well_-%_5.(,?....Distance from foundation----lQ_.__.._Distance to nearest lot line___��______ Number of lines_-_._____ __f .-_--Length of each line-laa__- - - ---------- _.- Width of _ � ---- -,.----.------- Type of filter material-_ . 0C�{ �----_Depth of filter material_._.l __.__.-Total length________--/ __Q------------------- Seepage _______________Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-_____.._--.--___ ❑ Number of pits----------------------Lining material--------.-.--. - ---.Size: Diameter-------------.--------.Depfk--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material___._..---------___._____.__.____-_ ❑ Size: Diameter----- ----------------- ----- ----De th--------------- p ------------------------------------Liquid Capacity ------------------------gals. Privy: Distance from nearest well-------------------------------------------_---.Distance from nearest 6uilding------------_-_______-_-__._ -------------- ❑ Distance to nearest lot line. Remodeling and/or repairing (describe):---------------------- ---------- ------------------•-------------------------------------------•-------------------------------------------------------- � ------tRR-r_6__.-- �31�Fat �Ng-------------------- ---- COn+t_haM.-f Z`tR-C?2 -------------------------------------------------------------------------------------------------------------------------------------------- ------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, ate laws, and rules and regulations of the San Joaquin Local Health District. (Signed - ----------------------- - ------------------------------------------------------ -- -----------------.(Owner and/or Contractor) By: --------- ............... .. `x (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----------f__ R-Q------------------------------------------------ ----- DATE------ REVIEWEDBY------- ----- -------------------------------- - -------------------- -------------------------- --------- DATE BUILDING PERMIT ISSUED---------------------------------------------------------------------------------- - ----------------- DATE Alterations and/or recommendations----------- ----------- ------------------------ ---------- ---------------------------------•-------•------------------------------ -------- FINAL INSPECT - r Date--.......... r �c� La--- --------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California