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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. --------- -------------------------- -- ---- ------ -- (Complete in Duplicate) !s Date Issued --------------------------------------------------------- This Permit Expires 1 Year From 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. 1rin -----: ------�� U----- JOB ADDRESS AND LOCATION-------- f �l �L .. - ----- Owner's Name -------------`----- :-'li.�[> "�- -------------- Address--------------- - - ----..._Address ---y.-L-----------------------------------------------------------------------------------------------_.-_---•---e------------------------------------------------------------- Contractor's Name------ --`------ `2- -------------------------------------------- ----_- Phone------------ -----------. Installation will serve: Residence N Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other L7 Number of living units: A---- Number of bedrooms --3.- Number of baths __`----- Lot size ----�7 7X___3_-9_0---------------------------- Water Supply: Public system ❑ Community system ❑ Private [X Depth to Water Table—s'l- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [❑ Clay Loam ❑ Clay ❑ Adobe (Z Hardpan ❑ Previous Application Made: (If yes,date--------..-------._.) No ;& New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No.septic,fank or--cesspool permitted if,pu6lic.sewer is available within 200 ct':` Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- ❑ No. of compartments---------- --- ----- - ---Size--------------------------------Liquid depth-------------------------.Capacity----------------------- y Disposal Field: Distance from nearest well__'7 ..._Distance from foundation ------------ to nearest lot line_.__-5---------- TX Number of lines___.___I-._._._ _.____---______-Length of each line--------�$_�._______-,Width of trench. .__. ` ��__ Type of filter material__-S P-O C-4,.Depth of filter material..... -Total length---------- _.______________________ Seepage Pit: Distance to nearest well-_�Qjf _-Distance from foundation--1Q/_-_`__.D,istanIce to nearest lot line_S ?"� �. Number of pits......./-------------Lining mate ria l �_•_.-&-ckSize: Diameter__ __ --------------- ---- Depth___--a_ 00 : Distance from nearest well-----------------Distance from foundation------------------- Lining material---_...------_----------.---_-----_-. ❑ Size: Diameter--------------- -------.Depth----------------------------------------------------Liquid Capacity---------------------- ----gals. Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------- ----_-. ❑ Distance to nearest lot line--.---- -------- ------- - ------------------------------------------------------------------------------- ------.------- ,0 Remodeling and/or repairing (describe) ----------[i_,A_ �..�- -----~�------- -Zi-'---5 _11- `__-� ---f - ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 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*reulations of the San Joaquin Local Health District. (Signed —P, `.-=------��------'--- h'"'` (Owner and/or Contractor) _By=�-- -----------------------------------------------= --------------_------------------ (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- ---IF4'---.2--- - ----------------------------------------------------------------------- DATE----,5=-- a_ ------ --------I-------- REVIEWEDBY-------------------------------------------------------------------------------- ------ ------------------ ------------------ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED------------- DATE----------------------- ---------------------------------- Alterations and/o recommendations:._.----. ....... .U_ ------0. ------------ - -----� �)- - ----- .._. 4 ---- --------�-- -�.�---- -------. ��---------------------------------------------- - --------------------::- --------------- -• -------------- FINAL INSPECTION BY: moi' Date... _�_3_^ti_tS -- ---- - ----- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C o.