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FUK UFFICE USE: ~_ 41 -------- . . .................. 3v APPLICATION FOR SANITATION PERMIT Permit No. >- -------------------------- ------------------------------ (Complete in Duplicate) -�-2 ---------------------•.-.- This Permit Expires I 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 AN LOCATION.. J-�' ---=--• -----— --------- �-/ '[ -------------------------------------------------------- - - --- -- - Owner's Name- �/--- --•• • --te) - - - --------•--'---------------••----------------------- -- ---------------------------- -- ------ Phone. ------------------- Address----------- ---------------------------- ` ;�� -3 Y Contractor's Name �/ Z--- --------- -------•------- ------------ Phone--- --•--------- Installation will serve: Residence ❑ Apartment House ❑ Commercial [❑ Trailer Coq=tt�otel ❑ Other ❑ Number of living units: __/_ Number of bedrooms ----/ Number of baths ---Z Lot size ---- Water __Water Supply: Public system ❑ Community system ❑ Private Ri-IDepth to Water Table�/ ft. Character of soil to a depth of,3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ O` Previous Application MadeM1r.(If yes,`date--------------------J No []?' New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: _ Septic"T nk: Distance from nearest well- -_� sewer is available within 200 feet.] (No septic tank or cesspool permitted if public 1-4 C'_-Distance from foundation__�_�-J.'____--_-.Material --______________________�Ce No. of compartments �' ` �--��-�-- -------Liquid depth-----�•-- CapacitY•---�4o.�•`' I � P �-------Size-- Disposal Field: Distance from nearest well_/f.l�.-----Distance from foundation__ 4..__.__-Distance to nearest lot line_--- L� Number of lines---------/-- - ------------Length of each line-----7 ----------------Width of trench.----.-- �----------____-- _ --Total length_-------�,!FA-1----------------------- Seepage of filter material____��_.!.�!1_4L1J.__Depth of filter material1._c�_�___ Seepage Pit: Distance to nearest well-1154- _��_Distance f om foundation-_�7�_�__. stance to nearest lot line f___.__... 1 ------Size: Diameter----&3.F�-- [ Number of pits-------f-------------Lining material. A_�. ---Depth---- '. .-------------_-- p nearest well---._-._.____--_Distance from foundation---_---------------Lining material------.-..------------___-_-________. Cesspool: Size:Diameter Weare = Depth -- ----------- ---------------------Liquid Capacity- - -----------------------gals. ' "] t Privy: Distance from nearest well---_-------------------------------------------.-Distance from nearest building----.-.--___________-_-__-__-___-------_- ° ❑ i Qistance to nearest lot line-------------------------- --------------------------------------•---------------- ------------1''°'- r I Remodeling and/or repairing (describe)--------------- -----------•---------------------------------------------------------------•-----------------------------------------------------------------------------------=--------- --------------------------------------------- ---------------------------------------------------------------•------------------------------------------•-------------------•-----------------------------------------------------=------------------------- -- I ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County I ordinances, Stlaws, and rules and gulations of the an Joaquin Local Health District. �v(Signed) ------- ------ caner and/or Contractor) BY: ----------------[Title) (Plot plan, showing size of lot, location of system in relation tow s, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- DATrE `T . REVIEWEDBY ------- -------- ------------------------ --- ------------------------------------------------------ DATE BUILDING PERMIT ISSUED---------------------------------- -------------------------------------- -------------------------- DATE-------- Alterations and/or recommendations:------- _ G ____ _ _-_-.,* ___ --------------------•------------------------.------ -------------------- ------------ ------------------------- ------ - ------------------ FINAL INSPECTION BY:. --------- Date------.. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi, California Manteca,California Tracy, California F.a.ca.