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FUK UrrILL USt: --------------------------------- ---------- ------------------------------------------- _ APPLICATION FOR SANITATION PERMIT Permit No. -___- _._. _-.. ------------------ -- -- - (Complete in Duplicate) Date Issued _ �1. �Y ______________________________________________ __ 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 th r hereindes n ed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION �� 4j�lr_l�/r_/1//�� --1 �`!-- t(�rl ----�'---�/X�-QL_!!Y ----tet _______ Owner's Namee--- .�--�p� ------------------ ------------------ -- ----------------- ---------•---------- Phone---•----------------••---------•---- Address--------.1G!__`-'-__,�'-_'_� l� `4JCF---------------- -------------------------------------------------------------------------------------- Contractor's Name-------- 4/0:�_ t -------••------•---------•-------------------------------•---------------- Phone----------------------------------- - will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ __ Number of bedrooms l-. Number of baths /___ Lot size ------------------------------------ Water Water Supply: Public system ElCommunity system [-] Private 4?< r epth to Water Table ft. Character of soil to a depth of 3 feet: Sand E] Gravel F] Sandy Loam ❑ Clay Loam Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No We New Construction: Yes Z?*"'No ❑ FHA/VA: YesZ? —No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta Distance from nearest II .'__Distance �om f u dation.Zn�.........Maty iaL.��'� L No. of compartments..................Size..SK------- 9 uid depth....��_-.__----------.---Capacity��..��___ Disposal Field: Distance from nearest wells-___._.Distance from founds -on___-V. _____Distance to nearest lot line_+...----- Number of lines__a�___-_�____ ________Length of each line_.&0f____ ___________Width of trench - _. ----------------- Type of filter material Qe Depth of filter material_ __________Total length__ _o� _________________----- Seepage Pit: Distance to nearest well----------------------Distance from fou-ndation....................Distance to nearest lot line----------------- El Number of pits______________________Lining material-_-______-___________.Size: Diameter-----------------------Depth_._._.__._-..-.---------_.---- 3' Cesspool: Distance from nearest well----------------- from foundation--------------------Lining material-------------.-_-____----...__._. ❑ Size: Diameter---------------------------------------Depth----------------------------------------------------Liquid Capacity------------------------ -gals. Privy: Distance from-'nearest well_-.-._-----------------------------------------Distance from nearest building-__.-__-_-_________--____ ❑ 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 reaulations of the San Joaquin Local Health District. i (Signed)-- ------------------------ - ---------------(Qa@aEEjUHttqr Contractor) By:---------------------------------------------- ---- ------------------ --- (Title)- ---------_..._..- (Plot plan, showing size of lot, location of system in relatio wells, buildings, etc., can be placed on reverse side). FOR D ARTMENT USE ONLY APPLICATIONACCEPTED BY--------------------------------------------------------------------------------------...... --- DATE--------------------_- ------------------------------ - REVIEWED BY-------------------------------------------------- ---- == : DATE. t - - - -------------_-------------- BUILDING PERMIT ISSUED: --------------------------------------------------------------- f DATE Alterationsand/or recommendations----------------------=•---------------------------------------------- ---------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•---------------------------•--------- ---------------------------- -- -- - ---- ----------- --------------------------------------------------------------------------------------------------------------------------------------------------------------- ----- ----------- ------- ----- - --- -..-..-- - ----------...� ...-------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:.......................... .------------------------------------ � Date---------------1--•----`--------------------------- ------- -- - --------- SAN-JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 2205 West 9th Street Stockton, California Lodi,California Manteca,California Tracy, California