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- ---------------------------- .. ----- -------------- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ---------------------_ -------- ------ This Permit Ex fres ] 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 Ag N__.___ 8 'S --- --- -- - --- - Owner's Name_" "-___ / Address--- -------------------------- -------- Phone-_-,------------------------------ - __ Contractor's Name_ _______ -- ___ ___.__._"_ _ _ Installation will serve ______ : Residence p - ----- Phone..- - I�A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _l-" Number of bedrooms .__ Number of baths __/_ Lot size .____ ___.. Water Supply: Public system � � �J- Y Community system ❑ Private �epth to Water Table -Yd ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel C] Sandy Loam El Clay Loam D?-*'C-la ..� Previous Application Made: (If yes,date_________. _" Y ❑ Adobe ❑ Hardpan C]---) No ❑ New Construction: Yes ❑ No 9?_00`FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) e t an Distance from nearest well __Distance from foundation___-"________"____.Material_--------------.---------------------No. of compartments-.---. --Size--------------------------------Liquid depth----------- - Disposa# field: Distance from nearest well.%51. f Capacity_____..___"___.____---- v�a Distance from foundation._--" k_-------Distance to nearest lot line_��_�___ Number of lines--------�___"__""" ---Length of each fine_,,l_-Q"-Q_`_--" _"" �/ti/idth of trench-,____ Type of filter material___J�__f/ac� it t!z_V_ -------y------ "._Depth of filter material_.__- _gTotal length--------------------�d lJ 1 Seepage Pit: Distance to nearest well----------------------Distance from foundation--------- Number to nearest lot line______--_____.__ ❑ Number of Pits---."______________._Lining material_-___ --------------- Size: Diameter-- ---- --------------Depth --- ---- ----------- Cesspool: Distance from nearest well -----Distance from foundation___________________ Lining materia)--. ----- -------------- ""-"-_ ❑ Size: Diameter----- ------------------------------Depth----------------------- -- - -- -----Li Liquid Capacity Priv - - - - - ------- q --- -------------- -----•--gals. y: Distance from nearest well-------------------------------------------- Distance from nearest building ❑ Distance to nearest lot line------ ---------------------- -------------------------- Remodeling and/or repairing (describe)_____________"_""-_ 14�4r ----------------------- I ------------------------------------------- --------------------------------------------------------------------------•------------•------------------------------------ --------------------------- All-IN \! laws and rules� ind,9gulations of the an Joaquin Local Health District.I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St (Signed) --------------- ir' --------- ----------------------------- ner"_.__ __ _____(O and/or Contractor) -------------- ---- -- - {Title} - $Y=------------------------------------- -••----- -- ------- ----- - - - - -- Plot plan, showing size of lot, location of system in relation----- - o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_._REVIEWED BY � .d �- �- -------- DATE._ T1 " - - -- -------------------------------- BUILDING PERMIT ISSUED-------------------------"""-- - --- ------ ---- --- DATE__._. ------------------------- - --------- ---------- •--------- ----------- ----------- --------- DATE-------------- -- ----- -� Alterations and/or recommendations:___.................. . FINAL INSPECTION BY. -. ----- ----- --- --- Dater- p ----- Cid SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th$tied Stockton,California Lodi, California Manteca,Cafifornia Tracy,California F.P.00.