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SE:-- FOR OFFICE USE- ------------------------------------ -------------------- ------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. - -1_- -- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued�o Ar-=rte----•� 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 I �� JOB ADDRESS AND LOCATION____A�__- °' Owner's Name-------- -'' - �x �`r'- I`v----------FEF,_K�� R-14------------------------- Phone------------------------------------ ��jj f �_ Address = •. '` h7. ' '1 ----------- ------------------ '---------------------------------------------------------- Contractor's Name '� ------ ``1 w'"� .__-;�- -��='^."``------- ----- cF_ . Phone Installation will serve: Residence eApartment House E] Commercial ElTrailer Court ❑ Motel ❑ ,Other ❑ ' Number of living units: _ ____ Number of bedrooms --2-- Number of baths __ °-.__ Lot size __._?°: "' ti_" :__------__________________ Water Supply: Public system ❑ Community system ❑ Private ®-"'Depth to Water Table ------ ff. Character of soil to a depth of 3 feet: Sand - Gravel Sand Loam Clay Loam Clay Adobe Hardpan P � ❑ Y ❑ Y ❑ Y ❑ ❑ ❑ Previous Application Made: (If yes,date-----------_________) No E-- New Construction: Yes ❑ No E— FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic,Ta/nk: Distance from nearest well-----------------Distance from foundation--------------------Material-------------.------------._________-_____._____. i �? �rr._� No. of compartments--------------------------Size--------------------------------Liquid depth---- -------------------.-Capacity-------------------- F Field: Distance from nearest well._.+S%�...�___Distance from foundation____��__________.Distance to nearest lot line___S--------- r❑- _ Number of lines-----------f----------- -------Length of each line------1A.&-`_------------Width of french___Z—__f_..-----_____---- -•.- 01 Type of filter material___Ad&_______ -- ______Depth of filter material____.14'-� ___....Total length_____- _------------------------- Seepage ___ _-------- 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------------------ - - ---------- - ----------------------------------- -------------------- ---------=-------------------------------------- I 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 - t ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) E `-`"' i '- ---------- --------- ----------------------------------------(Owner and/or Contractor) _g$Y•----------- --------yG-�------------------------------------------------------------- - - ------(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 APPLICATION ACCEPTED BY----.__. _4 R=o-------------------------- ------------------------------------------ DATE--------- ------------ I. REVIEWED BY--------------------------------------------- --------- -------- ------------------- ---- -------------- - DATE----------------------------------------------------- --- BUILDING PERMIT ISSUED----------------------- -------------------------- DATE------------------------_- -- ------------------------------------------------- --------------------------------- Alterationsand/or recommendations:----------------------------------------------------------------------------_----•------------------------------------------- ---------•--------------------- ' ---------- ----------------------------- -------------- ------------- ----------- - --------- - ------------------------------------------------------------------------------ ---------- -- --------------------------- ---------------- ----------------•------•-- ---•------------------------------------------------------- - - ------------- ------ - - --- ------------------------ --------------------------- ----------------- ----------•- ------ -------------- INAL INSPECTIODate. �`, `- ............................ ----- -- --- -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy,California F.P.CO.