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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No.-------------------------- ----- ------ -- ------------ ------------------------ -- (Complete in Duplicate) �/ Date Issued a- a1--=_ � ------ 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. _ JOB ADDRESS AND L CATION Z - J= f ----- ---•-------------------------------------------- + f � - Owner's Name--------- --------- ------ sr Phone/,,/' ` g Address l ------•-•------ Contractor's Name--------- --••-�k - Phoned Installation will serve: Residence ❑ Apartment House ❑ Commercialrailer Court ❑ Motel . Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths __ - Lot size ------------- Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table --------- ft. I . Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date-----------_--------) No New Construction: Yes J' No El FHA/VA: Yes E] No El 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--,c``U.�--.Distfrom foundation--- ( _____-----Material---- ------------ No. of compartments------�.__.__--.-..--Size,/_an/ce Size/0."X_4.-__`... -_-Liquid depth-_--_47-1-....--____.''Capacity/ �OP.614� Disposal Field: Distance from nearest well_ %:5`e-..._Distance from foundation----14---------Di tante to nearest lot line----1 _- ------ Number of lines___-__. -------- ______ ___---.___ Length of.each I ine__,`t -/fry_-7___ i�th of trench------�- ---------------------- Type of filter material---;6.4--------Depth of filter material---`� .........Total length----a_ l,0_----_------------------ Seepage Pit: Distance to nearest wel1..`4q-....Distance from foundation--/V--------- �Diistance to nearest lot line--- Number of pits.---�------ g ---- 7 -'Oi----- Depth--. ----- .__-..Linin material__._�a-4'� Size: Diameter__.__ . Cesspool: Distance from nearest well____.-_-°_____._-Distance from foundation--------------------Lining material_------------------------------------ 11 Size: Diameter------ ---------------•----- --- Depth----------------------------i--- - -----------------Liquid Capacity_-------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.------- .------____-__---__--..___-_.,._. ❑ Distance to nearest lot line---------------------------------------------------------------------- ------- ----•- -------- ------------------------------------- Remodeling and/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. (Signed) --------- -------- ---- --------------------- ----------- ----- ---- - -- ----------------- Owner and/or Contractor ----- ----- --------A' Title (Plot plan, showing size of lot, location of system inrrelation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- q.—_ ---------------------- --------------------------------------- DATE- —---------------------------- REVIEWEDBY-------------------------------- ---- --- --------- -------_;1--------------------------------------------------------------- DATE--- ------ BUILDING PERMIT ISSUED----------------------------------------- ----- �r ----------- ATE--- --- ------------------------------- , Alterations and/or recommendations:' ---------_- - ` -� �[-_' p -------------------------------•--------------------•--------•----------------------------------- ------ ----------------------------------------•--------------------------------------------------------------------------- ----------------- -------------------------------------------------------------- -- ------------------------ -------------------------------------------------------------------------------------------------------- FINAL INSPECTION B _ - ------------------------ Date.-- 3'7- ��7 ------------ _ r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ri i C.P.CC. 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