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¢ FOR OFFICE USE: x, ' %-------- APPLICATION 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 escfbed. l This application is made in compliande with County Ordinance No. 549 tq T JOB ADDRESS AND LOCATION__9 -_ - -- --------------- ----------- - --- Owner's Name r - � ------------- -- -------- ------------ Phone.r �cr_ Address _ - _ -- ------------------------------------------- rf ___-- - : Contractor's Name------------ ----- - ----------- Phone.-�fv�..}Y� `LLQ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trrrailetr Co rt ❑ Motel ❑ Other E I Number of living units: Number of bedrooms -------- Number of baths!_ size __-_ 6 -•----------• 1 Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table A2_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam lay ❑ Adobe ❑ Hardpan ❑ F Previous Application Made: (If yes,date__-----------______) No [ New Construction: Yes E44" ❑ FHA/VA: Yes ❑ No ❑ L TYPE OF INSTALLATION AND SPECIFICATIONS: ., r (No septic tank or cesspool permitted if public sewer is a ailable within'240 feet:) y Septic T k: Distance from nearest well__5 `_--tDistance' from foundation-_ G____------.Material__ _:' --� -� - _ �r ` No. of compartments----�----------------Size-��_K,�_Y�__:----.---Liquid depth----�-r-___.---------Capacity__�Q4_.` j�-�: Disposal field: Distance from nearest we€I_,5.P_'__t._Distance from foundation_� .__-_____.Distance to nearest lot line_kS` I [ p Number of lines-------/-------- - ---- Length of each line___r 10-f----------------Width of trench_...:I,'. --------------------- � , - C Type of filter material___ ! ?C_ k--Depth of' filter material__._9--t--r---------Total length-------�Cx_F__--_------_-_______-_._ rJ t ` f ` Seepage t: Dis#ance to nearest//wellrl______. __-Distanc, om foundation--_7t��__..___. Distance to nearest lot line_- .___._-__ Number of pits------L--------------Lining material_�__�.-.<_._..Size: Diameter._'3.......____.-Depth_.. S----------------------- E5"Cesspool: Distance from nearest well_________________Distance from foundation--------------------Lining material_._-..._.---____-.-.____________-_-- ❑ Size: Diameter--------------------------- ----------Depth-------- - -------------------- - -----------------Liquid Capacity----------------------------gals. Distance from nearest building Privy: Distance from nearest well-------------------------------------------------- 9 ------------ --------------------------- ❑ 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 Countyc� ordinances, State laws, and rules and re dations of the San Joaquin Local Health District. {Signed}------- - - h�� - - - ----------------------------- {O ner and/or Contractor] BY:----------- ------------ --�` j -------------------------------(Title)-----•- �- - - -- ------ (Plot ----(Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - 'e__Pl X ---- - �------------ DATE------- l� C� ----------------- REVIEWEDBY----------------------------------- -------------------------- --------------------- --------------- DATE BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------ ------------------------------ Alterations and/or recom dations: ----- _-�� -� - E-------- ------------------ ----------------------------------------------------------.-.----..--.-------------- : FINAL INSPECTION $Y'- 4 Date..... (7--C7---------- -- ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT t 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F,RCC.