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--- FOROFFICE USE: \ _ _____T_�__________________ APPLICATION FOR SANITATION PERMIT Permit No. Qf.( --------- ------------------------------ ------------- - (Complete in Duplicate) Date Issued ... .------------------------------I-------_--------- .._ 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. 1-7 JOB ADDRESS AND LOCATION_--• 1- `7Y..-...... ��' r-t------- 1`-------•------------------•------..--•-•------------- Owner's Name--------- -`14--------'`V_1_1-1_fzt� ' ------------------ ------ Phone------------------------------------ Address---------------_- -----------------------------Address---------------_-1_.Y --------- / --P--1` ---------- -Y ----------------------•---------•--------------------------------.---------------•---•---------------- Contractor's Name------ 1 : -------- - ,c------------------------------------ - ----------------------------•--------------- Phone..!-(.. Installation will serve: Residence ®"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/____ Number of bedrooms J-____ Number of baths -L___ Lot size ------7 K_.-K_--_(-'Q_____._.______-__--___ Water Supply: Public system ®'Community system ❑ Private ❑ Depth to Water Table .G_41 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E— Hardpan ❑ Previous Application Made: (It yes,date--------------------) No g-- New Construction: Yes ❑ No Ra' 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----------------------- pisposal Field: Distance from nearest well---/Yq______Distance from foundation____---.--------Distance to nearest lot line_ ______._ Number of lines------------/----------�----Length of each line_____c,{-Q - - ------.Width of trench__4--------------------------- Type of filter material----�a�-_____----Depth of filter material ____ _ ------------Total length_____, _._____-_--____-_-__________.- Seepage Pit: Distance to nearest well-----*-------.---Distance from foundation----10---__.___.Distance to nearest lot line_.-f-_--.__.__ Number of pits------1-------------Lining material---AdQ.G. -.---Size: Diameter----__ L-��-_-Depth-..Z�_�-----------_______ \4It 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---------- ------ - --- --------- ------------------------------------------------------------------------------------------- -------------- 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 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. �� 44 (Signed)_________s '' _Z_._._____ ._ _- ._________. --------(Owner and/or Contractor) j By:---------------` -� -------------------------------------------------------------------------------------------(Title)---------- ------- ---- --------- (Plot plan, showing size of to+, location of system in relation to wells, buildings, etc., can be placed on reverse side). 4 OR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ ------ ------------------ ------ --------------------------------- DATE--------- --------------------------------- REVIEWEDBY--------------------------------------------- ---------------------------- ---------------------------------------- -----•--• DATE------------------------- ---------------------------------- BUILDING --------------------------------BUILDING PERMIT ISSUED------------------------ DAT - E.------------------------------------ ---------------------- l - - - ----- - --- - - Alterations and/or recommendations:--------- ._�G = ----------------•-------------------------------------------------- -------•-------- --------------------------------------------------------------------------------------------------- ---------------------------------------------------------------- ------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ FINAL INSPECTION BY: --- 16- ---------------- ------- Date----------. ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California