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— FOR OFFICE USE: 6 =• it y _____ 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 instal4 the work herein descried. This application is made in compliance with County Ordinance No. 549. 1A__�[� JOB ADDRESS AND LOCATION: _- 1 ---- � --+d 5- --- __'3''Z�IP---- --'� '�J�--- Owners Name- ------ -� �'- 15; -------------------• --- ---------- - - ------ -------- Phone--- Address------------ -Address------------I xf;p- Contractor's Name---- f7 � +/ --------- - Phone----------------------------------- Installation will serve: Residence tApartmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _l_-- Number of bedrooms___ Number of baths _ r_ Lot sizer -- �--- ------------------- Water Supply: Public system ❑ Community system ❑ Private ®—Depth to Water Table !49 ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay t Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date....................) No New Construction: Yes P--No ❑ FHA/VA: Yes Z4—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Septic Tank: distance from nearest wegll__.f-�______Distaff e from fo nda ion__l _....-_..Ma�rl /'' �------ i___ _----p�� " No. of compartments__Ez!"-----------------Size..7,�,_-_`ZX,fLiquid depth__ _CapacitY._ .----. f Disposal Field: Distance from nearest welL40�- -Distance from foundation__ _.f....Distance to nearest lot line,_ ._____ Number of lines_- -'---/--- .___ engfh of each line___ ------------Width of trenche._._-.-__________________ 4, Type of filter material - __Depth of Filter material___. . -----Total length__ _ -----------------•---- `, 1 f / ` �l Seepage Pit: Distance to nearest well--- �_____Distance fro foun ation___42 -._____.Distan��e to nearestlotli` ___ ®/ Number of pits.._.___...----_.Lining material__ � Size: Diameter__,,,? ------Depth,Depth,SV_�I�/�� Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------------_._____________ [] Size: Diameter---------------------- -------Depth----------------------------------------- ----------Liquid Capacity----------------------------gals. Priv Distance from nearest well__.________-------- ------- ..........Distance from nearest building-----.-_____..__------------------------- y:. ❑ Distance to nearest lot line- ---------- ------------------- - ' ,0 ��- -------------------------- ---- Remodeling and/or repairing Idescrit�e]:_--__-..__1112e-141 ` ---------------I---------------------------------------- _______ ----- --------------------------------------- ------------------------------------------------------------------------------ -------------- ------ ----------------------------------- -- - 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. r Contractor -------------- ------ ---- -- ---------- -------------- Sy:--------------------------------------------------------------------- . ------------(Title)- -- ------- ------ (Plot plan, showing size of lot, location of system " elation +o wells, buildings, etc., can be placed on reverse side). n " FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY----------- C _ -. :.. DATE--- r ,�l --------------- DATE ----------- -------- - REVIEWED BY------------------------------------------ -- -------------------------------- --------------------- --------- -------------------------------- - -- --- -- ----------------------------------------------------------------- BUILDING PERMIT ISSUED------------------------- ------------------------------ DATE Alterations and/or recommendations--------------------- -------------------------------------------------- --------------- -------------------------------------------•------------------------- ----------- Date----- `�~' 3 -- ��--- ----------------------- FINAL INSPECTION BY:.._�-r��..,�<v-_-- ----- -- ------- .p 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.