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[yam APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) Date lssu d ___: 3Qt� 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 her ' riled. This application is made in compliance with County Ordinance N . 549. JOS ADDRESS AND L CATI N --- ----- ----- ---------------- ---- ---------------------------------------•---•------------------------------------------- Owner`s Name___._ :_. Phone Address .4• � - --.uu: ............... / Contractor's Name....----- -- -----------•---------- Phone. ------------------------ Installation will serve: Residence par ment House ❑ Commercial ❑ Trailer Court ❑ Motelr❑ Other 0 Number of living units: ']----- Number of bedrooms _,,,7_-- Number of baths _-/.--_ Lot size Water Supply: Public system [R�Clmmunity system ❑ Private ❑ Depth to Water Table 4%!—ft. - Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [2r`A~ardpan ❑ Previous Application Made: Yes ❑: No New Construction: Yes No ❑ FHA/VA:.Yes ❑ No []----- TYPE OF INSTALLATION AND SPECIFICATIONS: " (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic Tank: Distance from nearest well —------Distance from foundation___4-._________-Material 4�-- --- ---------_----•- No. of compartments______ Size------ _�(Si'_ Liquid depth_ ... -----_-Capacity__ Disposal Field: Distance from nearestell....__.---__._Distance from foundation_ uDi �nce to nearest lot li H___ -�__.-- [�..- Number of lines---------- ------------ ----- -----Length of each line___-_ �_----------------Width of trench------ i-y------------------•--l` n Type of filter material__�OC___ ____-Depth of filter material----f-t-_____________Total length__-) -------/J- .__'_-- Seepage�it: Distance to nearest well___._ '�_________Distanc�eom foundation___f�_�.._.___.Di§ta �e to nearest lot fi �___..__gJ Number of pits.__._______-_--_Lining material___.! aa4'_...Size: Diameter__3x�-- Depth Cesspool: Distance from nearest well-----------------Distance from foundation-------------------_Lining material-_.________-_____-----__-____._______-m ❑ Size: Diameter--------------------------------------De Depth Liquid Capacity- - ---------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building___._.____---------_________._______._. ❑ Distance to nearest lot line------------- -------------- ----------------------------------------------•------------------------------- - b tR Remodeling and/or repairing (describe) [-- ? AA - MWAt-------bIV--------- ----- r�-jTT—Z7----------- ------------------•---- ----------------------------------------------':----------------------------------•--------------------------------------------•---------------------------------------------------------- ---------------------- ----------------- ---- ------------------------------------------------------------------------------------------------------------------------------------------------------ --------•---------------------------------- 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 les and regulations of the San Joaquin Local Health District. (Signed)--------------- - -- --------------------------------------- ---------------------------- -------------------- ---------------------(Owner and/or Contractor) ., By:------------------------------------------------------------------------------------- --------------------{Title)-------------------- ------ ------------ - - ------------ (Plot 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---------- I -------------------------------------------••-------------------- DATE------ . 7-0_` . REVIEWEDBY-------------------------- ----------------- ------------------------------------------------------------- ------------------ DATE------------- ----------------------•----------------------- BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE---- Alterations a d/or rec dafimns_______ __ ____ __ __ t ------ ----- ------ �----------------------------- ---- - ------------- { e --- --- ---------------------------------- -STC -/= � - - -- FINAL INSPECTION BY:.---- �B`f Date---------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amarican Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ti `5-9-2N. Revised 8-'S9 F.P.Co. t