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FOR OF I�E USE: = / APPLICATION FOR SANITATION PERMIT Permit No. _______________________ f-------------- --------- ------- ------------ (Complete in Duplicate) f� �,� --------------------------------------- - Date Issued ------•-------------- :_-- -_-------K-___-_-__.___ This Permit Expires 1 Year From 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 in compliance with County Ordinance No. 549. OL.Z, f' - - ------- -----------------•-••-------------•------------- .............. JOS ADDRESS AND LOCAN....2_67M Phone----._.----•--••-------------------- Owner's Name-- g,-n ---------------- Address-....42$ 7 ...... (F - ------------------------------------------------------------------------------------------------------•---------------•---- .... y Contractor's Name------------r�•`-------'---••-{---�-..�---(----------• Phone. .... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms -1_ Number of baths .f----- Lot size _r7_4 "_Q;'--------------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -� ft Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay ❑ Adobe[THardpan ❑ Previous Application Made: (If yes,date--------------------) No Er New Construction- Yes ga--No ❑ FHA/VA: Yes ❑ No [�J— TYPE OF INSTALLATION AND SPECIFICATIONS: , (No septic.fank or cesspool permitted if public sewer is available within 200 feet.)` / Septic Tank: Distance from nearest ------Distance from foundation_1k------------Material-------�J_------------ --------------------;x e No. of compartments---2--------------------Size.... .Y-AXJ-------liquid depth----y-- O Capacity--$ !_ Disposal Field: Distance from nearest well__Z!r -C--_Distance from foundation_,10_-2-x—.i----Distance to nearest lot line_-----_---______- Q ❑/ Number of lines___:__ i---------=-----------Length of each line.......... ................Width of trench -..--,_________________-. Ir`�,' Type of filter material__�zC_'�----------Depth of filter material___1_$_.____--...Total length___-_--IW_!_....___________________ (A Seepage Pit: Distance to nearest we11_ !�Q------ --Distance from undation_�QZ_A, *.___.Distance to nearest lot line. + Number of pits-----_2...--.------Lining maferial, -----Size: Diameter-_ _ _�� Depth----- ___ f 7 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----_.-______--___________-_.------------- v ❑ Distance to nearest lot line------------------------------------------------------------------------------ --------------------------------------------------------------- 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 laws, and rules and regulatio of he San Joaquin Local Health District. ----------------------------------------------------------------------(Owner and/or Contractor) (Signed) -- --------- BY: •---- ------"` -- -- ------------------------(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__ -----_i _'__ -!� ----------------------- DATE---- - - .� ti_-- -------------------------------------------------------- REVIEWEDBY--------------------------------------------------------- ------------------------------------------------ DATE BUILDINGPERMIT ISSUED----_----------- ----------------------------------------------------------------------------------• DATE------------------------------------------------------------ Alterations and/or recommendations:--------------------------- ----•------------------•-------•-----------...-------•-•-------••---------..-......-------------------••---------- -------- --- -------------------------------------- -- --- ------ - _---• ----------_------------ � ------------- •---------------- ------------------------------------------------------------------- ---------------------- ----------------------------------------------- ------ FINAL INSPECTION BY: __-: - Date----------1--� --1- --- ------------------------------------------ , -r� SAN JOAQUIN LOCAL HEALTH DISTRICT F 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E9.9 Rr VIDE0 0.59 F•F-CO.ZM L I