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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ..P,/) - __ _ _ _ (Complete in Duplicate) Date Issued yr�� ----------------- 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. r JOB ADDRESS AND � � ------------------ �-- ------------ -----------------------•--- Owner's Name7�,C----�f/,,� �rl�'r,"''( --------------- Phone------------------- ----•--•-------- Address----.1_j ------ ---- ----1-1 -----------------------------------. ---- ------------------------------------------------------------------- Contractor's Name �- - `J r Phone -•----•-•--- Installation will serve: Residence ❑ Apartment House ❑ Commercial M/T•railer Court ❑ Motel ❑ Other ❑ Number of living units: ..-- Number of bedrooms J- Number of baths -3--- Lof#size ------------------------------------------------------------ Water Supply: Public system ElCommunity system ElPrivate Depth to Water Table .6Uft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay E] Adobe 2--HardpanC] Application Made: {If yes,date----- --------------.] No F-1NewConstruction: Yes ❑ : No UP---FHA/VA: Yes ❑ No [�^ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within.244,feet.)., Septic an6 y► Distance from nearest well-----------------Distance from foundation......--------_----Material........-----.......-.------------- ------------- No. of compartments -Size __Liquid depth Capacity.. Disposal Field: Distance from nearest wells... Distance from foundation-/_4--------------Distance to nearest lot line..-__-..... ❑ � Number of lines-- ---------•------------------Length of each line.-..6 ----------------.Width of trench... _ ..-°----------------- -------Total length- - . �- ----------------------- Type of filter material704../j�_-.Depth of filter-material---- o ilter material--.f g / Seepage Pit: Distance to nearest well/t'4..�__._...Distance from foundation.-.l�--..__-_.•�ist e to nearest lotA-1571line.__ a .1 -----------Depth Number of pits....__ -- ---Lining material�D_L . ..___....Size: Diameter--.- t Cesspool: Distance from nearest well-----------------Distance from foundation-_.---------------Lining material---......---------------------------. ' t i ----..-.-Li.-Liquid Capacity -_---gals, ❑ Size: Diameter----t--------------------------------Depth----------------------------- q p Y € .Distance from nearest building. Privy: Distance from nearest well-------------------------- ---------- 9 : 7 ❑ Distance to nearest lot line----------------------------------------------------------------------- ---------------------------------------------------------------------- . '" .00 { 1 F ---- U Remodeling and/or repairing (describe):-------------------- -------•------------------------------ ! I ------------------ ---------------------------------------------------------------------------- s 1 ------------------------------------------------------------------- ---------- ------------------------------------•----------------------------------------------------------•--•------- ---------------- ----------- -------------------- ---------- --- - - = --- ---------------- --------------=---------- ------------------------------------------------------------------------------------------------------------ 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 a 'd regulati ns of the San Joaquin Local Health District. Si ned ------------------ ------ - - - ----------- ------- ---------------------------- --------(Owner and/or Contractor) ( 9 - ----- --------------------------------------------------------(Title)------- -------------------- ----------- ---- ------ (Plot plan, showing size of lot, location of system'in relation to wells, buildings, etc., can be placed on reverse side). I '} :( FOR DEPARTMENT USE ONLY ----- APPLICATION rACCEPTED BY---------- ---_- �. --- ----------------------------------------------- DATE_._- - �. � REVIEWEDBY- -------------------- ----------=- :- , DATE----- -----------------------------•--------------------- BUILDING ---------------------BUILDING PERMIT ISSUED---------------r----------F ----.. DATE------------------------------------------------- --------- Alterations and/or recommendations. ---------------------------------------------------- ----------------------------- ------ --- ---------- -------•----- ----•------- --------------------=----------------------------------------------- ! ------------------- --:-t-�=---------- ------ ----- - -- - FINAL INSPECTION BY: t Date..... ----�1 ----------------------- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Av*. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC. - 4