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rv>< vrri�. c u3r: .1 ------------- 14- ------------------------------------ ------ APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------- ---------------- (Complete in Duplicate) - -.- This Permit Expires 7 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. JOB ADDRESS AND LOCATION _--230---"',� `-/� _ �r� �' _ � jJz �%u --- ------- ------------------------------- Owners Name --------------------------------------- -- -- ---------------------------------- ---- Phone------------------------------------ Address1!-1<e ----------c--------------------------------------------------------------------------------------------------------------------------------------------•----------- Contractor's Name------ ---c_7 ----------------------------- -------------------- --------------------------------------- Phone----------------------------------- Installation will serve: Residence trApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 1______ Number of bedrooms____ Number of baths _1_____ Lot size __ !!!�------------------------------------------ Water Supply: Public system ❑ Community system ❑ Private P'Depth to Water Table e---- ft. Character of soil to a depth of 3 feet: Sand P] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------_-----I No t'-New Construction: Yes ®'�No ❑ FHA/VA: Yes ❑ No © — 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___--�tl_ -------- Materia#_____ --'' ------------- -- No. of compartments----Z-----------------Size_S��X� _2__'Liquid depth__ _i_11............. / �'_ Disposal Field: Distance from nearest well-.k:T7Q-.-__Distance from foundation__Zp__1-_._____-Distance to nearest lot line__`_--____ Number of lines___---.--------------------___Length of each line__,9A/x-6 - _ 4_ -_-_ .Width of trench--S�_�___-_-._..___.____ Type of filter material_X&C-_�C__-_-___Depth of filter material_.1_r-_`.'_--------Total length---/�-a__--____________ Seepage Pit: Distance to nearest well------------------_---Distance from foundation--------------------Distance to nearest lot line_______.__-_---_. ❑ Number of pits-----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well---------_-------Distance from foundation....------------ Lining material--.-_-_.._-_._.__________--______.._. ❑ 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}-- ------ ------------ ------------------------------------------------------------- ---•------------------------ n �-q--- - --------------------------------------------------- ------------ ------------------------------------------------------------------------- ------------------------------------------------------------------------- -------------------------------------------•--------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State Ir,*s, and rul d re ations of the San Joaquin Local Health District. (Signed) 4 LAA. =`--------------------------------------------------------------- -(Owner and/or Contractor) By:--------•-----•---------------------------------------------------------------------- ---------------------------------------------(Title)----- ----------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR:DEPARTMENT USE ONLY r APPLICATION ACCEPTED J- BY te/ �Z -------------------------------------------------------------------------------- DATE-- I/ C REVIEWEDBY-------------------------------- ------------ -------------------------------------------------------------------------------- DATE----------------- ------------------------------------------ BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------- -------------- DATE Alterationsand/or recommendations----------------------- -----------------------------------------------•---------------------•------------------------•-----------•------------••------------- ---------------------------------------------------------------------- ------------------------------------------------------------------------------------•---•---•------------------------------------------------------- --• ------------------------------------------•--•------------------------------ ---------------------- • •-- ------------------ ---------------------•----------------------- FINAL INSPEC N BY: -- ---- ---- Date- -- - ----- .. .----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxeiten Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca, California - Tracy,California