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FOR OFFICE USE: =G 7 --------------�� APPLICATION FOR SANITATION PERMIT Permit No.------------------------------------------------ � �~� --- ------------- -------------- ---------------------- (Complete in Duplicate) Date Issued --- -- -------- ---------------- --- 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 herein described. This application is made in compliance with County Ordinance No. 549. —;Z ,' I / JOB ADDRESS AND LOCA iON___A_ .Ah, -_---W __ _ ti '�`"` - w 1 Owner's Name-----ltd/ _..-__.__ Phone_____________________ - ----- - -•-------- -- ---------------�--f- --------------- ---- -------- - - --- -------------------------- - --------------- Addressr��-�p�0'x--G'/----------------------------------------------------------------------------------------------------------------------------- Contractor's Name ...Z—S----------------------------------- -------------------------------------------------------- Phone---------------------------------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other ❑ Number of living units: ----I-- Number of bedrooms __. Number of baths . __ Lot size --___/'g-_1�_ '`1---------------------------------- Water Supply: Public system,F] Community system El Private �]epth to Water Table s�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 New Construction: Yes No ❑ FMA/VA: Yes Er--N`o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) J4 SeptiTank:_Tank: Distance from nearest well_•5�--.---Distance from foundation_40----------Material _. IE3 No. of compartments-------._Ia....----------Size------- depth_-._____4--- ----Capacity-_/Za4_�--_- Disposal Field: Distance from nearest well__Sd..R.._Distance from foundatio ._ Distance to nearest lot line-IS-__----_-- [ � Number of fines-------2 _-- ----- -- --Length of each line - ----------------- -- ---Width of trench -------- ------------------ - Type of filter material-----_?."_ .......Depth of filter material__/fl".` --___.._Total length___ 5eepa,3e Pit; Distance to nearest well---------------- _____Distance from foundation--------------------Distance to nearest lot line----------------- F1 Number of pits------------------ ---Lining material----- -.- ----------- Size: Diameter-------------- --------Depth--------------------------------- Cej;spool: Distance from nearest well-----------------Distance from foundation....................Lining material------------------- ..--_-_--.- ❑ Size: Diameter-.--. --------------- ----------------Depth----------------------------------------------------Liquid Capacity----------------------------g Privy: Distance from nearest well------------------------------------------.-.- --Distance from nearest building-----------------------------------._____- ❑ Distance to nearest lot fire----------------------------------------------------------------------- ----------------------------------------------------- -------------- 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 Count ordinances, State laws, d les and reg do s of t San Joaquin Local Health District. (5i ned g ) =------- -- (Owner and/or Contractor) By-------------------------------------------------------------------------------------------------------------------------------------(Title)-- ----------- --- ----------------------------------------- (Plot -------- ----- - ----------(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-- ---------------- -------------------------------- DATE--------�A_77.4-? REVIEWEDBY-------------------------------------------------- ------------------------------------------ DATE------- --------------------------------------•----- - BUILDING PERMIT ISSUED-------------------- ----------------------- ---------------------------------------------------- DATE-------------------------------------------------..._.• Alterations and/or recommendations:------ -------- ------------------ ----- ------------------------------------------------------------------------------•- ------ ----------------- ---- ---- - - ----------------------------•------------------------------------//--//----------------------------------------- ---- ------ ----- FINAL INSPECTION BY:. -- --- ---------------- - Date------7___- --- __- _ . 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.P.C r].