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rUK LAIR-t USt: ....-.-, ,� 1 2 5` -------------------_---------------------- ---.---------- APPLICATION FOR SANITATION PERMIT Permit No. --------------- ----------------------------- ------- (Complete in Duplicate) ------- -- This Permit Expires 1 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 OCATI N_--•---------------- -- ----------------------- -=---'= ---------------------- Owner's Name - ----• --- -------•------------------- ----F-- --------------- -------------- Phone------------------------------------ Address--------- --------------------Address--------- --- - ----- ----- --------------------------------------------- Contractor's Name---- - --- --- -- ------ --- ------------------------------------------------------ Phone-------•---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: /-- Number of bedrooms__ Number of baths /._ Lot size __- Q_ -v, - -----• - ------ ----------------•-------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam [-❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ A Previous Application Made: {If yes,date......_. ._------- No New Construction: Yes ❑ No P,- FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic I a Distance from nearest well_ --�Distant from foundation---,,-/ Mat i -_ ------------- [� No. of compartments_-- ------ --- -------- - --.-._Capacit aG?-- ---- b Disposal Field: Distance from Weare t weILC _-_.-Distance from foundation__ _ . Distance to nearest lot line---- ----------- Number of fines_-_ _________ _____Length of each line7�y�.�1_- .)Distance trench__ ---------------------- --- 1�of filter material ___-._.__.___--------Depth of filfer material..__/"-`____-..Total length------I�-d-�---------------- 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. P I Privy: Distance from nearest well__________________________________________ __...Distance from nearest building - ,- ___.-- ❑ Distance to nearest lot line---------------------------------- --------- Remodeling and/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 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) ---- - ____.. wner an or Contractarl -- 13y' �- - ---------------------------------------------------(Title)- - . .---- - ----- , (Plot plan, showing size of lot, loc tion of system in relation to wells, buildings, etc., can be placed on reverse side). j FOR DEPARTME USE ONLY APPLICATION ACCEPTED BY,,; _ ti-------- ------- --- --- - ---- DATE- REVIEWEDREVIEWED BY------------------------------ ------ ------ --------------------------------- - ------------------------- --- ......... DATE 6 -- - -•------------------ BUILDING PERMIT ISSUED----------- ------------ -------------- ------------------ DATE-------- Alterations and/or recommendations:_--_--. �_- ---,-- - _ --_-_- G ,�,1� 7 ------- ----------- - ------------------------------- ---------------------- - ---------------------------------•-----------------------------------•--------------------------------------------------------------- --------------------------------------------------- --- -- - -------------•---- -----------------------------•-----------••------•--------------------------------•-----------•--- ------------------------- ------------------------- -- - -------------------------- --------------------------------- ------- ------------------------------------ ---- --------------------------- _-------------------------- FINAL INSPECTION BY:.-- L .�7� Date.---- �_` -- -/J �a yr ----- --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California F.P.CO.