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FOROFFICE USE: �_--a.`t*.4---------------I`---6. _ ---------------------.f`7 ------- A PPLICATION 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- OwnerOwner's 's Name,,-7011,V__----- 4 A..�--------------------------------------••-------------------- - - --------------------------------------- Phone------------------------------------ Address---------- Contractor's Name �--� -•----------------•--- Phone----------------------------------- Installation will serve: Residence [Zj-- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ , Number of living units: ---r--- Number of bedrooms 3--.- Number of baths .---- Lot size ---- ---------•_____----•----.------ Water Supply: Public system ❑ Community system ❑ Private [g4--Depth to Water Table 4.r-ft. 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 ET- New Construction: Yes ❑ No lq*- FHA/VA: Yes ❑ No 2?'-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi ank: y Distance from nearest well--_-------------Distance from foundation--------------------Material---------------------------------:--..-..-------. / No. of compartments--------------------------Size--------------------------------Liquid depth---------- ---------------Capacity------ ------------- Dispose/ Distance from nearest weil..IA�q------Distance from foundation--- Q-----------Distance to nearest lot El Number of lines---------I-------------------_---Length of each line----S-¢-_'---------------Width of trench Type of filter ------Depth of filter material.../-$---------------Total length----%�;7a--_-.-------_------------- Seepage Pit: Distance to nearest well-ArO--g____Distance Distance-from oundation--$'+S-r�--..-- Distance to nearest lot line--/P-0------ W--- Number of pits....I_______.------Lining material_-�---.-.Size: Diameter -----------Depth------Z---5-__---.----.- Cesspool: Distance from nearest well-----------------Distance from foundation__________________ Lining material--_--_-_.---_--_______----.--.------- ❑ Size: Diameter----------- ------ -------- - -----Depth--------------------------------------- ------Liquid Capacity----------------- ----------gals Privy: Distance from nearest well-------____-----------------------_-- ---------Distarce from nearest building-------------------------------.---.---__. -Ir ❑ 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. f (Signed)------------------------------------------------ ---------- ---------------------- ----------------------------------------------------------------(Owner and/or Contractor) BY: ------- -----------------------------------------------------------------(Title)---------------------------- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------e7-yo-------- ------------------------ ------ DATE__ `/ "'Al ----------- ---------- ------- -------------------------- REVIEWED BY-------------------------- -------------- -- ----------- ------- ------ DATE------- ---------- BUILDING PERMIT ISSUED------ •---------------------------------------------------------------------------------------------- DATE----- ------------------------ Alterations and/or recommen do s:--.--------------------- --- ------ - ----- ------- ----- ---- --------- l.x-:- -- .fr ------ --- -- - - ----------I------------------------------------------ ---------------------------------------------------------------------------------------------------------------•------- ------------------------------------------- -- ----------------- -----------------------------------------•----------------- ----- --------------------------------------------------------------------------------------------- I - --------------------------- --------------------------------------- ------- ---------------------------------------------------------------------------------------•---------------------------------------- - --------- ------------------- F]NAL INSPECTION BY: _ Date -----------------------V-------- -------------- - --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.