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f FOR OFFICE USE: jr G I ------- APPLICATION FOR SANITATION PERMIT Permit No. 4! --------- .2, _ (Complete i 1 Duplicate)I o,- ----------------- ----------- Date issued -� This Permit Ex fres'l Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. I JOB ADDRESS AND CATION /- �: ------- !� ---------------- Phone------------------------------------ ---------------------------------------------- Name. ----- --`-�=- -- - -- - -----------------------------------•-------- ------------- ---- -- 1 Address.----------- ----------- --------------------------- ----- -------------•--------- ---------------------•-------------------------•---•- Phone------------------Contractor's Name----------- � ---•- Installation will serve: Residence W,-"Apartment Nouse ❑ Commercial U. Trailer Court ❑ Motel ❑ Other ❑ ` u I Number of living units: -,/ -. Number of bedrooms _-Al. Number of baths __ -_ Lot size ___ -_ 1 `��-------- 14� Water Supply: Public system [Community system ❑ Private ❑ Dept`h to Water Table t. ' Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Sandy Loam Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No M✓New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: i (No septic tank or cesspool permitted if public sewer is available withi., 200 feet.) ! Septic Tank: �.. Distance from nearest well-----------------Distance from foundation-.-----------------Material------ -. I G67f�'��f No. of compartments--------------------------Size-------------------- ----------Liquid depth---------- ---------------Capacity---------------------- i Disposal Fiel Distance from nearest well _ --._ -.Distance from foundation--------------------Distance to nearest lot line----------------- .`� //a� Number of lines-------------------------- ------Length of each line;t-- -- -----------------------.Width of trench...--.------------------- --------- Type of filter material______ Depth of filter material------------ _ _ --. ------- ..Total length--------. _----__ -..----__---------- Seepage Pit: Distance to nearest well-.-_____' '_.-.- bistarice from fou dation___P°' ___.Distance to nearest lot_line________________ .---._Lining. material___ f Size: Diameter--.�_rF---_.__.Depth `�__ � Number of pits.___f__..__. --? 1 Cesspool: Distance from nearest well-----------------Distance from foundation.--_---------------Lining material....____.---------------------------- 1 ❑ Size: Diameter-------------------------------- ---Depth_ -------------- at-------- - --------- Liquid Capacity----------------------------gals. t ` Privy: Distance from nearest well...................____-------------------,-----Distance from nearest building.__._-.-__._._._____________-------- ---. 0 '0 ❑ Distance to nearest lot line---- -- = ----- - -------------------------- -------------------------------------- ------------------ ----------------------------------------------- Remodeling and/or repairing (describe)---------------------- - ;. ----- ----------------------------------------------------- ------------------------ --------- -------------------- ------------ -------------------- ---------------------------------------- ----- -----------------------------------------------------------------•------------- ! If ------ k 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 reg ations of the San oaquin LoU" ealth District. I e ((�ry�eror Contractor) ' (Signed)------------------- -- ---- r f ' - ----------------- - - Title __ Sy:--------------------------- -- --------- -- ( } i (Plot plan, showing size of lot, location of system in rel to wells, uildings, etc., can be placed ori reverse side). FOR DEPARTMENT USE ONLY --------------- -- -°$' '------------------- --------------- APPLICATION ACCEPTED BY--- - ---------------------------- - DATE -- REVIEWEDBY-------------------------- ---------- It----------------- - DATE---------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------- ll -------------- DATE------------------------------- ------------------------------------------------- -- -and/or recommendations: ------------------ - - ----------------------- -- 1- ---------------- cI ---------------------------------------•- --------- - ----------------------------- ------ ---------------------•------ -----------------------•---------•-------------------------------- ----------------------- ----------------- --------------------------- -- ------------------- -------•-------------- --------------------------------------------------------------- --------------------------------------------- -- Date ----� —- `�-------- ---------------------------- FINAL INSPECTION BY: --- --- t, \ r�' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.f{aielton Ave. 300 West Oak Street 12`Sycamore Street� 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracyr California i F.P.0 O.