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FOR OFFICE USE: ------------ ��------ APPLICATION FOR SANITATION PERMIT Permit No. ------------------ (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. S49. • ----------------------------------•-------------••- JOB ADDRESS AND LOCATION---,�9�--�------� - 1-------------- --------------- LPhone------------------------••-•-------- Owner s Name---- - ----- -- ------ --------- ----- -- 12 Address-//JZ----------• . -� `------ --- / --- Contractor's Name--------------------- --------- - ------------ ------------ Phone..1-4-- .3�- Z Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: _-/.- Number of bedrooms -/- Number of baths --/- Lot size .___`r -�---ARa--------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table s'O ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe MIlHardpan ❑ Previous Application Made: (1f yes,clate-----------7........) No ❑ New Construction: Yes ❑ No [N�FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) nkj Distance from nearest well-----------------Distance from foundation_---_-_-..__---___.Material-------.--.-__------_-_----_--___--..----..----- No, of compartments----- -------------------Size--------------------------------Liquid depth-------------------------Capacity----------------Iti posal field: Distance from nearest wells_Distance from foundation--,/4----___..-.Distance to nearest lot lin .g________. Number of lines_____J_.._.____ ------ ---Length of each line.--__-1�- o_'..._,...-_.Width of trench..-.-- ----e--------�.._---.--- Type of filter material-5'x/ 0,4-`�----Depth of filter material----.-p?-�/__ Total length.............. �Q }� 4�21Seepage i Distance to nearest well1____Distance from foundation___-0r`_t0____--_.Dista�ce to nearest lot hP_.._4�3 ------ --Linin material__ _Q-. . ...__.Size: Diameter-_ _--_ Number of pits... g Depth ' W Cesspool: Distance from nearest well-----------------Distance from foundation------------.------ Lining material--._..------------------------------- M ❑ 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):------ r -------------------- ----- k --------------------------------------------------• 3 . - •--------------- ----- -- ------------------------------------------------------- -----------------------------------------------------------------------------•---------------------------•--•------------------------------------------------------------------------ ---------------------------- --------------------—---------- ---------------------—--- ------------------ ---- ---------------------------------------------------------------------------------------------------------------- I herebycertify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, §4ate laws, and rules and regulations oft San Joaquin Local Health District. ------ -- -------- ------ --- - - - - -- ----- (Signed)---- --------- --- --- -----(Owner and/or Contractor) - - ----------------------(Title) (Plot plan, showing size of lot, location of system in relation to wAlls, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------- ------I-------- ------------.----------------------------------------------------- DATE---��= -------------------------- REVIEWEDBY-------------------------------------------- ----- -------------- ------------ ---------------------------------------------- DATE-----------•------------------------------ ---------------- BUILDING PERMIT ISSUED---------------------- ------ 1A--------- ---------- j----------- ---------- DAU.-_6 j Alterations and/or recommendations:- .1. ¢> - --4- e ------------------- -<>�� ----------------------------------------------------------------------------------------------------------------------------- - ------------------------------------------------ ------------------------------------------------------I----------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------- ---- -----------------------------.-.--------------- ---------------------------------------------------------------------•-- -------------- ' � Date.----- ------ �' � ------------------------------- FINAL INSPECTION BY________________ �Z --- -�- - - �- - - �- 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.CC.