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FOR OFFICE USE: -- ---3d s Y -- ----------------------------, _. APPLICATION FOR SANITATION PERMIT Permit No. --1._______...---....1_ --�--------------------- - - -'" (Complete in Duplicate) -------- ------- -- This Permit Expires i Year From Date Issued Date Issued ____ __ -. S Application is hereby made to the San Joaquin Local Health District for a permit to construct a install the work herein described. This application is made in compliance with County Ordinance No. 549. F .r 1 JOB ADDRESS AND CATION-.�'---� - --+�`-- -f-- - --- ��-- ----�----- -- cr-�--/- /-- ��--/--------- Owner's Name --- -•-- i --- ------------- --------------- Phone_T-----_Z` Address------------------ Contractor's NarA:ZL .r--- ---- ---- -- _ t 1 Ph _ ,y// ------ --- - - - - --- - -------------------- Installation will serve: Residence [ partment one ___House Commercial ❑ Trailer Cou Motel ❑ Other ❑ Number of living units: I------ Number of bedrooms _�_ Number of bath ________ Lot size _T .. -.�. - Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 12.0ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ ay ❑ Adobe [&_<ardpan ❑ Previous Application Made: (If yes,date_ -___ ] No ❑ New Construction: Yes jr No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if blit sewer is available within 200 feet.) Septi Tank: Distance from nearest Awe11A�1J�_E_Dista''n//,�c,y ro qiv d iPn__1------------- erial._&_l ITCJ�&dler- No. of compartments__z-------------_----size_�rw____��_�7 Liquid depth_ z2.__._.__.____ Capacity----- Disposal r Disposal Field: Distance from nearest well__�t1��Distance from foundatyon---._/�_____Distance to nearest lot s�l//i��ne____ Number of lines______f..__ - _ ength of each line_____ ----©__�--- Width of trench.- -2-54 !Y r Z--------------- Type of filter material-- epth of filter material_____ _ _________Total length___.___.____ Q__________________ 1 -- Seepage Pit: Distance to nearest well----- 0lR. istance from foundation--- - ____.... Di�tanc�to nearest lot lin ____: Number of pits.__ �._._.-------___Lining material__�G_ _. - Size: Diameter_ ___ __t0_____--Depth----1941 ---------------- 1' Cesspool: Distance from nearest well.----------------Distance from foundation-------------------- material______...._._.____________._________- R r 1i Liquid Capacity_ gals. ❑ Size: Diameter---- --------------- ----------------Depth - ------------- --------- q P y- -------------- ----.- 9 6 Privy: Distance from nearest well_________________________________________ _._ _Distance from nearest building.____. ----------------------- .------.... .: ❑ Distance to nearest lot line.- --- -------------------------- ---- ----- - --------------------------------------------------------------------------- Remodeling and/or repairing (describe):---------------------- -------------- ---------------------------------------------------------- -----------------------------------•------------------- , ---------- -----------------------------------------------------------------•------------------------------•---------------------------------------•--------------------_---------------------------------- ---------------- ---------------------------- --------------------------- --------------------------------------------------------------6r ------ I hereby certify #hat I ha v prepared this application and that the work will be done;in accordance with San Joaquin County A ordinances, St a n e and regulation of the San Jo uin Local Health District. 1 (Signed} '� �' "= £ontractorj B (Plot plan, showing size of lot, location of system in relati to wells, buildings tc,'cen 6e placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- t ------- ------------------------- ---------- - --- ---------------- DATE-------- :f --_ j REVIEWEDBY--------------------------------- ----------- --------- ----------- -- ------ ----- - --- - ------------------------- ------ DATE---------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------ ----------------- DATE---------------------------------- Alterationsand/or recammendati s: ---------- --------------------------------------------------------------------•-----•-----------------------------------•------------------- --------- ---- -- ------------------ ---------------------- ---- ------------- --7�"T--_- =5_ .__ s^� �.�rf'_'C"_'Y{..J�_ -- - -. - `ai°^-- -__�_____ r--------...------------ - ------.-------------------. -, FINAL INSPECTION BY:.---- - -- .?e--------- -------- ----- ----- ------ - Date___.` Z, /------------ - - -- - --------------------•---- 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.C{7-