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vR vrrit—r- ubt: --- --�. ---- -- � '. ---- --- ' '------ --- ------------- - ;r APPLICATION FOR-SANITATION PERMIT Permit No. ..................... (Complete in Duplicate) _ --- ----------- ---`------------------------------------ This Permit Expires 1 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 AND-LOCATION_..__ �� ... : I Owner's Name----- f_ --------------------------------------------------- - ----------•--- Phone Address--------- ,---•-- Contractor's Name_______ , 'ti e� `-------- Installation will serve: Residence ❑ partment House ❑ Commercial ❑ Trailer Court ,, ❑ Motel ❑ Other �� Number of living units: Number of'bedrooms --^_- Number of baths rr ___ Lot size4OO_f� -------ZZO—- Water Supply: Public system ❑ Community system"0 Private ❑ Depth to Water Table ft. PP Y� Character of soil to a depth of 3-feet:` Sand 'Gravel ` 1 ❑,,��andy Loam f] Clay Loam ❑ Clay ❑ Adobe l��ardpan [] [ _ Previous Application Made: (df yes,date__ .________ No ,, f W r ®`'`New Construction: Yes �o ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welt---- QDistance from foundat on__�-___--__,Mat ria_ p ��1®�- No. of com artments____cid----------------Size "" ✓ r t ! + Liquid`deptil H' -----------Capacity--- f l ------- Disposal Field: Distance from nearest wel)__��-----_,Distance from foundation__ ,,,�* 2,- 7_-- JDistance to nearest lot line___>a-___j.._ --- will Number,of lines------- ---__ Length of each line_ f I i Type of filter material_--� g y ----Width of trench_,_'°r.� ------.-- ---- ------- ,y - --- Depth of filter material_/F-_-_- „=Tof'al{,len th___,C { � 9 .�------------------------ Seepage Pit: Distance $o nearest well__ -�---- -Distante fro foundation- - t f �r ��-------.Di"stance to nearest lot line.' f----_ Number of pits.---,-------------Lining materialSize:Miameter._ Cesspool: Disfancelfrom Distance€from nearest well__-------------Distance from foundation------------------- 1;inirl.g material__._-_--_-----__..-------_ Did❑ Size: Diameter---- -------- --- ---- ---- -------- Depth__ -----------------------( ------ L iqu;6 Capacity----------------------------gals. Priv __ -,,� , Y= Distance from nearest well._._________________ --___Distance from nea(est,,buiidin Distance to nearest lot line___ I � ----------- __________ Remodeling and/or repairing (describe)-------------- ---------------------- ----•------------------------ -� - ----------- ----- I hereby certify that I have.prepared.this,applicafion=aiid 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. (Signed)--------------- --- ✓ --------- -- --------------------- BY: --t--- ----------------------------------- Title ---- -- �/ Contractor) ) (Plat plan. showing size of fat, location of system ' elation to wells, buildings, etc., canbeplaced on reverse side l ) FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---_- -' L5 —� PATE - ~�------------ REVII=WED BY- --- ----- --------- ----- .............................. � - - ------------------------------------------------------ -- ------- DATE----------------------------- - UILDING PERMIT ISSUED - 3 ----- ----------- ----------- ----------------- ------- - ----------------- DATE---------- --------------- �- ------ - Alterations and/or recommendations:---- -' --/p_ 4 � ------------------- 42-------------------------=- ------------------------------------------- I i ----------------------------------------------------------------------------- -------------------- -------------- ---------- ........• --------" ----- - -- FINAL INSPECTION BY:..__-.-._.----�-- - _7 Date- ------- 1601 E.Haxellon Ave. SAN JOAQUIN LOCAL HEALTH DISTRICT .- . 300 West Oak Street124 Sycamore Street: w Stockton,California Lodi4Californiir , t 205 West 9th Street Manteca,California Tracy,California F.P.C Q.