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FOR OFFICE USE: --------------------------------------------------------- f ._.._..._______________________________________----- APPLICATION FOR SANITATION PERMIT Permit No. __�_!__-_d� ------------------------------------------------ (Complete in Duplicate) -.----. --- This Permit Expires 1 Year From Date Issued Date Issued .__ 1 _ Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work he in s'crbed. This application is made in compliance with County Ordinance No. 549. Z.foo i A/• ry i C c4 o LS r JOB ADDRESS LOCATIO� 111�__ pi-d_- -- fix._- -- d--- --------------- --.!oc+a -� ------- -i ----- a. Owner's Name-- 7'--- --- --- ---------- ------------------------- - �- - Ph6f?eC1�C jo Address------------- ----71 Y. . ---------------- c ' rJ Q - ----------------- -- Contractor's Name______ � �.. v- . �--------------------------------•------------- Phone----•--•----• --------✓•---•------- Installation will serve: Residence j tment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___J__ Number of bedrooms _ '__ Number of baths _Z--- Lot size _._ __ __ _____ ____________________________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel F] Sandy Loam ❑ Clay Loam ❑ Clay dobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New-Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No [I 1 TYPE OF INSTALLATION AND SPECIFICATIONS: `�} (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p Septic nk: Distance from nearest well-----ri_lq------Distance from foundation___ A- _ --------- _ .Waterial______. _ ____________________ ___. 21, No. of compartments-----�-------------Sizer��r �� S-�--Liquid depth------q--- ---------,. Capacity..._t.a�-*_ Disposal field: Distance from nearest well----.-�.._Distance from foundation___J_ _'______-Distance to nearest lot line---------- ---- Number of lines________-_a2-------------------Length of each line------/670...`_------------Width of trench.Z__--_.._________.._______._--_ Type of filter material----- sR=__.___.__Depth of filter material_._.__�_�l__�`.-------Total length--• --------------------- ______ �+ p a . 1 � f ------ See Dis#ante to nearest well from foundation___. .Q__.._.___Distance to nearest lot lisle___ _________ Number of pits----.C�----------Lining material___.�R -___-Size: Diameter.....I '`____Depth___. S-___________.___ Cesspool: Distance from nearest well_________________Distance from foundation--------------------- 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 certifLanrules prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laand regulations of theSan Joaquin Local Health District. (Signed)-------------------- -.16w+w and/or Contractor) BY:---------------- - ------ ------------ ------ -- -- --- ----------------------------------- -----(Title)- - ..._...-------------- --- ---------= - - _---------- (Plot plan, showing size of lot, location of system in elation o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ ,_ ,e!� ----------------------------------------------- ------- --------------------------------------------- DATE REVIEWEDBY ------ --------------- ------------------------------------------ DATE---•-------------------•----------- -------------------------------- BUILDINGPERMIT ISSUED---------------------------------- ------------------------------------------------------------------- DATE--------------------------- Alterationsand/or recommendations:----------------------------------------------- -----------------------------------------------•------•------•------------------------------------------------- -- -------- ---------------------------------•-•------------------------------------- - --------------------------------------------------------------------------------------- ---------------------------------- ---------------------- ------------------------------------------------------ - -- - ------------------------------------------------------------------- ------------------------------------------------------------------------------ -- ------------------------------- ---- ----------------- ------------------------------------------------------------------------------------------------------ ----•--- FINAL INSPECTION BY:....,/ ---------- Date--4--- � 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Avo. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca, California Tracy,California F.FP.;o.