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FOR OFFICE USE: ------------- ------�--------- --------------------------------- -11- -------------//:j o APPLICATION FOR SANITATION PERMIT Permit No. -------------------------------------------------------- (Complete in Duplicate) Date Issued -------------------------------------------- This Permit Expires 1 Year From Date Issued r Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein descr-ibed. This application is made in compliancewithCounty Ordinance No. 549. JOB ADDRESS AND LOCATION-_-6 `SY.--- ,-..� - �r rr ...------------------------- --- -------------------------------------- ------------------------------------ Owner's Nam --�---C.=j- --------------------------------------------------------------- ----------------------------------- ----- - Phone-----•------------------------------ Address.----...---4-Y'2./ � . Contractor's Name---- � Phone----------------•---•.............. Installation will serve: Residence Apartment House ❑ Commercial p Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __(----- Number of bedrooms ----.P—Number of baths __/... Lot size __j6 XVAP-----.....-._------------------------- Water Supply: Public system D—Community system ❑ Private ❑ Depth to Water Table .-G--oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe EF—Hardpan ❑ Previous Application Made: (If yes,date..------ -----I No E�r New Construction: Yes,C] No [!�r FHA/VA: Yes ❑ No p— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk:f Distance from nearest well-----------------Distance from foundation---------------.---Material.------.----.-.-------_-_---_-----.-'---------- No. of compartmef ts-------------------------Size----•-•---------------:---------Liquid depth-..------------------- -- Capacity---------------------- ' Dispos Fiei'd: Distance from nearest well-----------------.Distance from foundation--------------------Distance to nearest lot line_.----------_-_ / Number of lines_ --4---------------------_-------Length of.each line------------------------------Width of trench.---------------------------------- Type of filter,material-------------------------Depth of filter material-----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well.-. -----_------Distance from foundation-1A-----------Distance to nearest lot line-0---------- Number --------Number of pits----I---------------Lining material-----%2o_cAr----Size: Diameter------2-3-`------'bepth---- 1r"�------------------ II Cesspool: Distance from nearest well-----------------Distance from foundation------------.---.--.Lining material---------------------------..-------_ ❑ Sze: Diameter-----•t--------------------- Depth-------------------------------------------- ------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------__---.-_-_. ❑ Distance to nearest lot line------------•------------------------------------------ ------------ ------------------- ------------------------------------------ r Remodeling and/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 a�and rules and r ulations of the San Joaquin Local Health District. (Signed) ------ -------------�--- - (Owner and/or Contractor) By: * `- Title Y ------- ---------------- ------- ------ -- - ----- -- ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r l FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ -- ------ ------ --------------------------------- DATEU - --- ----- -------------- ------- -�''-L--^---- - - REVIEWEDBY------- ----------------------------- --------------------------------------------------------------------------------------_ DATE-------- ---•------------------------------ --------------- BUILDING PERMIT ISSUED--------------------------------------------------------------- -------"----- ---- ------- -- DATE---------------------- --- ------------- --- - ---------- Alterations and/or recommendations:____-" "--- _ `.- "__ � - t �`� A+" F- �� r/ --- --- -•--------------------------------------------------------------- --- -- - -f�`! j--------_ """��'{/--_-_ ---------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- - FINAL INSPECTION BY:-- Date - c-------------------------------------------------------- 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 F.P.r:O.