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FOR OFFICE USE- ------- SE-------- --- ® / .................................. ................:..... APPLICATION FOR SANITATION PERMIT Permit No. ----- -------------------------------------------- (Complete in Duplicate) G� Date Issued --- .. ........................... This Permit Expires 1 Year From Date Issued -- -l�--� 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 L" CA N--- ---v_ ------- `------------------------------- Owner's Name ------------------ --------------------- F Phone------------------------------------ Address------------------- ,� .rte -----• Contractor's Name------- t'�i f - _ �_ �/ ------------------------------------------- --------------- Phone.. ---------- _________________________ ---____'--. f Installation will serve: Residence [L Apartment House [❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/__ Number of bedrooms 2- Number of baths _--- Lot size _WAI�Iiell;r �----------------------------- Water Supply: Public system ❑ Community system ❑ Private P'-`Dpth to Water Table 10� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [❑ Adobe ardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No K--_FHA/VA: Yes ❑ No j TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank, Distance from nearest well-----------------Distance from foundation------------------- Material----_----------_------ ----------- ___._--------- /� �'�� No. of compartments--------------------------Size--------------------------------Liquid depth---------------- ---------Capacity--------------------•-- Di�posal Field: Distance from nearest well_ __ _________Distance from foundation----------------.--.Distance to nearest lot line------------- .� Number P ber of lines--- ----- __ ___ Length of each line-----------------------------Width oftrench-------------- ------ V' Type __ of filter material------------ ----_- --Depth of filter materia----------------------- Total length---------------------------_-------------. -I M Seepage Pit: Distance to nearest welC_ s -/'�-_-__Distance from��fou�ndation-_-: _-._-_.l Distance to nearest lot ane-"1-1 ----- t Number of pits_----/..---.-_.--Lining material__ i!1'- --.Size: Diameter___ _--- D,pth_;A __/--__/ ., Cesspool: Distance from nearest well-----------------Distance from foundation....-----.--------- Lining material_______----------- ---_------_ -. ' Size: Diameter-------------------------------------De th-----------------------_-----------.--------- -----Liquid Capacity gals. ! Privy: Distance from nearest well ...---_----------------------------------------Distance from nearest building-----...------._--------------.---------. ❑ Distance to nearest lot line--------- ----- Remodeling and/or repairing (describe) ,-'i T / - -. :_ -->-------•------- � -------------- -------------------------------------------------------- i ----------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------- ---- t 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 t e San Joaquin Local Health District. (Signed)------------------------------ ----- �/✓,_ ---- -------- '(O>?v r=t�n ror Contractor) By:-------------------------- ----------------------------------------------------- ! (Title) '-------- ------------------- (Plot plan, showing size of lot, location of system in relation wells, buildings, etc., can be placed on reverse side). FORD ARTMENT USE ONLY APPLICATION ACCEPTED BY - ------ ------------------------------- DATE-------6 JAG- - -- REVIEWED BY---------------------------------------- DATE -------- ---------------- BUILDING PERMITISSUED-------------------------------------------- ------ DATE--------- Alterations and/or recommendations:-------_T f- ....C/-Ej ---------------------•--•-------------- ' ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------ ------ -• ---- - ---- ---------------------- ------------------------------ 5 FINAL INSPECTION BY:--- --- Date---- ---� ------------ I SAN JOAQUIN LOCAL HEALTH-DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street F Stockton,California Lodi, California Manteca,California Tracy,California F.P.Ca. S yyk