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U/ R OFFICE USE. ------ -/_766 - ----------------------------------------------_-------.r APPLICATION FOR SANITATION_ PERMIT Permit No. �` ...c� ----------- --------------------------------------------- (Complete in Duplicate} Date Issued ---------------------------------------------------------- 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. JOB ADDRESS AND L CATION------- -��-----,--- __---'I•bf �--••---•----------------------------------------------------------------------------------------------- ----------------------------------� - ..17.111-11- Owner's Name--------------------- 5------ its- ------------------ ----------------------- ----- -- -- --- Phone. Address----------------------------t-AA4w--------- ,, Contractor's Name--------------------------jowluo*---------------------------------------------------------------------- -•-•----•--- Phone..........................--------- Installation will serve: Residence [ partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----- __ Number of bedrooms ___ _ Number of baths ----I- Lot size ----------400e.�/,�Gttlt------------ ----------- 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 ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------I No New Construction: Yes [jo-P+v❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__ _ _Distance from f0ation------ ________.MateaL..Cg114 _______ _________ No. of compartments-. _ _ ---_______-_Size_---____-- --___----___Liquid depth-_._.__�a—---------Capacity__-�+ Disposal Field: Distance from nearest weF-iRP......_Distance from foundation___. ________Distance to nearest lot line_________._ 21' Number of lines--------------3-----------------Length of each line----------- -- ---------Width of trench........47t Type of filter materia L:+� Depth of filter material __./''---------Total length----------- -__-.- -__--- 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----------------- from foundation--------------------Lining material----------------------________-__--__ Size: Diameter---------------------------------- ---De th---------------------- -----------------------------Liquid Capacity gals. Priv Distance from nearest well------ _-----._-------------------------------Distance from nearest building ❑ Distance to nearest lot line ----------------------------_----------------------------------- Remodeiing and/or repairing (describe):--------------------------------------- -----------------------------------••-------------------•------------------------------------------------------- pI ---------------------------------------------- -----------------------------------------------------------------------------------------------------------•-------------------------------------------------- -------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, t laws, and rules and r uI tions of the San Joaquin Local Health District. Si ned -- Owner and/or Contractor 6 {Title}_ Y•-------•------------------------------ (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 I APPLICATION ACCEPTED BY -• -------- ------- -------------------------- ---------------------------------------- DATE--------&44C------------------------------ REVIEWEDBY------------------------------------------------- ---- --------- -------- - ------- -------------------------------------- DATE----------------------------------------------------- ---- BUILDINGPERMIT ISSUED---------------------------------- ------------------------------------------------------------------ DATE------------------------------------------------------------ -- -------- Alttirationsand/or recommendations:--------------------------------------------------------------------------------------------------------------------------- ----------------------------------- ---•------------------------------------------------ ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------------------------------------- ------ ------------------------------------------------------------------=-------------------------•------------------------------•------------------------- ----------------- ----------- ------- ------ -----------------------------------------------------------------------------------------------------------------------------------------------------------------•------------ ----- -------- --------------------------------------------- - -------- --- ----------'-------- ------------------ ----- ---- ------------------------------------------------------------ FINAL INSPECTION BY:. " --- - ----' Date_f Q---------7 ------4---------------------------------- // 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.co.