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- �� APPLICATION FOR SANITATION PERMIT Permit No. ._ '.1.... (Complete in Duplicate) y� Date Issued ---- i � 4 Application is hereby made to the San;'Joaquin Local Health District for a permit to construct and i Il the work her, in described. This application is made in compliance with County Ordinance No. S49. ' ----- ---- JOB ADDRESS AND TION _ ._____ -�� LC - r a Owner's Name--------- ----------- ------ ------------ ----- ----------=----------------------:---- Phone - eL7 i Address---------- ------=-a__771 ...... --------------------- ------------------- - -------- -------------------------------------.... -----�'-- -- -------- Contractor's Name-- ~---- ----------�--------- -_- ----`------------- -------------------------------- -------- --- Phone # Installation will serve: Residence rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ` r -- Number of living units: ______: Number of bedrooms___ Number of baths __Vot size _____ft577__ ------ -------- ._,�_...� Water Supply: Public system �mmunity system ❑- Private ❑ Depth to Water Table ft. I Character of soil to a depth of 3 feet: - Sand ❑ Gravel 0 Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hard an Q Previous Application Made: Yes ] No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ � TYPE OF INSTALLATION AND -SPECIFICATIONS: SeeNo septic tank or`cesspool permitted if public sewer is available within 200 feet.) Tank: Distance from nearest welly---Y.�.-------Distance from foundation--------------------Material_---._----__-.__--.-----. y . No. of compartments--------------------------Size--------------------------------Liquid depth-----------------------:--Capacity----------•----------- Dill Field: Distance from nearest well_________________Distance from foundation-------------------.Distance to nearest lot line----_----------_- S Number.of lines-----------------------------------Length of each line------------------------------Width of trench----------------------------------- �/ Type of.filter material_________ ______ Depth of filter material------ Total length_-_-__--.-_-----__-.._____-__-_-_-__--_ Seepage Pit: Distance to nearest well-- ____ __Distance from foundation______ ________:Distance to nearest lot line---- .-._._.._._. rP Number of pits-------------- ------Lining material__ ocl -------.-Size: Diameter___ p r-- Cesspool: D stance'from nearest well-----------------Distance from foundation--------------------Lining material--------------------.------.-._-.----- ❑ Size: Diameter ----------------------- - --s Depth----------------------------------------------------Liquid Capacity---------------------------gals. l Privy: Distance frominearest well ------------------___.----_----.-.-------------'Distance from nearest building-__ ❑ Distance to nearest lot lire--------- ------ ------------------------------------------------------------------------------------------------------:------------------- Remodelingand/or repairing (describe-----------------------------------------------------------------------------------------------•---=-------------------------------------------_........ •----------------------------------------------------------------------------•-------------------------------.------------------------------------------------=------------------------------------------------------------- ----------------------------•-•----------------------------------•------•-------------------- ----------.-------------------------------•---------------- -------- - ------ ------------------ I hereby certify that I have-prepared this application and that the work will be done in accordance with San Joaquin County ordinance aws, and rules an regulations of the San Joaquin Local Health District. (Signed)--- _6----------------------" -------------------------------------- - ----- - - - ------ ------------------------=--- -- 2�r Contractor) r Title (Plot plan, showing size of lot, location of system in.relation o wells, buildings, +c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-. __. ------------------------------------ -- ------------------------•--------------- DATE�- REVIEWEDBY----------------------------- -------------------- ----------------------------------------------------------- DATES.-----------------------.-__.----------------------- BUILDING PERMIT ISSUED--------------- ---------------------------------------------------------------------------------- DATE-___U7--------------------------------------------------- J, Alterations and/or recommendations----------------------------------------------------------------------•-------------------------------- �3 ------------------------------ f ---------• e2.1_r — ----- -------� �--R u��'r ---------- -- - ---------------------------•---- -/ ------------------------------------------------ -------------------------• ---------------=------ ------------------------ --------------------------- -------------------•----------- . ---------------•------------------------------- ------------- ------- --------------------------- --------------------- --=--- ,- --------------------------------------------- -------------------------- FINAL INSPECTION BY:---------.- � _____-.._ Date-------- a .y --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wes+ Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi,-California Manteca, California Tracy, California L9-2M . Revisea )-57 F.P.Co.