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.... .. . .. .. FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ------------------------ --- -------------------- - -•--- r ------- - -- ------------------ ----------------------- (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 in compliance with County Ordinance No. 549. L/ JOB ADDRESS AN �_Zpp CATION--- - Y-------Zt,14---r - ---------------------•-------------------------------------------------------------------- Owner's Name-------- ----- ----"--- -------------------- --- - Phone----------------------------------- Address--------------- ----------------------Address--------------- - -----==-=--=-------------------------------------------------------------------------------------------------•-•- I Contractor's Name.----------- -- - -- - ---- ----------------- --------------•---------'----•------------------------------. Phone--------.. --_--------•---------- Installation will serve: Residence R3-- Apartinent House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other El Number of living units: __/__ Number of bedrooms _2-- Number of baths _,�___ Lot size ��i�� Water Supply: Public system T---C—ommunity system ❑ Private ❑ Depth to Water Table -4-aft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe F4-�ardpan ❑ I Previous Application Made: (If yes,date....................) No [ New Construction: Yes ❑ No 29---FHA/VA: Yes ❑ No Q� 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 foundation----.-------------- Material---------.---...______.__________..___._____.__. No. of compartments-- ------- ---------------Size--------------------------*-----Liquid depth---------- ---------------Capacity------------ ------- Disposal -Field: Distance from nearest weli._!!T- ------Distance from foundation_-,Z.--------Distance to nearest lot line__l '-_._-__- Number of lines___.____l_..... , Length of each line____ _ `p_._.Width of trench- _-`___ _____________________ ---Total length-----%p----- ---------- f"Type of filter materialf�/�Q ___.__Depth of filter material-__/ ________ _ ------------- . i Seepage Pit: 'Distance to nearest well______ `.______Distance from foundation----A0------.Distance to nearest lot line__] ._____. Wim' Number of pits----f--------------Lining material___,/�Q .Size: Diameter_._ Depth_Wd--x,44_ .c_ Cesspool: Distance from nearest well-----------------Distance from foundation___-----------------Lining material------------------------------------.- ❑ Size: Diameter---- -- ------------------------------De th--------------------- -------- - - ------- Liquid Capacity gals. Privy:' Distance from nearest well------------------------_ _____________________Distance from nearest building_________..___________'_________.___.-_ ❑ Distance to nearest lot line----------------- ----- -------------------------- --------------------------- -------------------------- Remodeling and/or repairing (describe).:----- d`4`D� �r Z2' ` -------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------- --------------------------- -- ---------------•----------------------------------------------------------------------------------------------------------------------------------------- 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 regulations of the San Joaquin Local Health District. (Signed)------------------------------------- ------------------------- ----(aelor Contractor) By:-------------------------------------------------------------- ---------------------- -- -- -----(Title) � _�.------------- ----- (Piot plan, showing size of lot, location of system in relati wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = - - ----------------------------------------------- DATE.----4^---- —-- --'�--------------------------- REVIEWEDBY------------------------------------------- ------------------------------------------------------------------------------• DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------- ------------------------------------------------------------ DATE------------------------------------ ----------------------- Alterationsand/or recommendations-------------------------- ------------------- - -----------•-----------------------------------------------------------•-------------------------------------- FINAL INSPECTION BY:. / --------------- --- --------- Date -4� ��' SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.00. i