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FOR OFFICE USE: ------------------ ----------------------------- ------------ ------ -- --------------------------------- ----------------------------._-_.__.________________________________________._. APPLICATION FOR SANITATION PERMIT Permit No. ------ --- ------ --------------------- - - ------------ (Complete Duplicate) This Permit Expires 1Year From Date Issued Date Issued�c `�d�_ , 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. 2-331 e. W iM.a.t o JOB ADDRESS AND LyOtCATION______ r _�---- -------- ----------�-._----1�"- 1��'7� -- 005--IaSo--/S -------------------------------- Owner's Name----- ---i✓- _ _ __ .-___ _ -- ---- ----------------- ------ --- --- ....... ------ -------------------------- --- - Phone----------------------------------- Address - •--- --- - -- Address — .....------ ------------- Contractor's Name---------F4' yyf -40m ------------------------------------------------------ - ---------------------- ---------------- Phone----------------------------------- Installation will serve: Residence [M Apartment House E] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: _�____ Number obedrooms __ ___._ Number of baths . ^"o Nbf � -�---- Lot size -- ------ ----------r------------------------------ Water - ---- - -- --------- Water Supply: Public system ❑ Community system ❑ Private Qj Depth to Water Table 4.D_ it. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam 11 Clay ❑ Adobe ❑ Hardpan-& Previous Application Made: (If yes,date_________ --------- ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ Y TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation-----------------. Material----__._---_____-_.___.___________________._____- ❑ No. of compartments----- ------- ----- - --Size---------- ---------------------Liquid depth---------------- . Capacity----------------------- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line------------_____ ❑ Number of lines-----------------------------------Length of each line--------_---------------------Width of tranch_-----.----------------------------- Type ----- --.-__ Type of filter material______ _________________Depth of filter material---------- ------------ otal length-------._-________-____-_'__-___-__ Seepage Pit: Distance to nearest well... a._._____Distance fr jfoundation- ¢_---________.Distance to nearest lot IineS___-_________ Number of its____ _Linin material-_�!]--------Size: Diameter----3$'__ --------De th_0.�.-_•3-_____________________- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material---------------------------------- -. ❑ Size: Diameter_.--- -------------- ---------------Depth-------------- -----------------------------------Liquid Capacity----------------------------gals. Vi W- Privy: Distance from nearest well______________________________________________ __Distance from nearest building_______-_-_---__-.--__________.._______._. ❑ Distance to nearest lot line-- --- -------------------------- --------- ----------------------------------------------- - --------------------------------------------- m Remodeling and/or repairing (describe)-------- 44 -_X__ , -- - --- ----------------------------------------------------- ---- -- ------------------------- ------------------------------------------------------------------------------ ----------------------- -- ------ ---------- ------------------------- ------- --------------------•------------------------•------------------------------------------------ ----------------------------------------------------------- ----------------- ---------------------------- ---------------------------------------------------------------•---------------------------------------------------------------------------------------------------- ------------------- ------ I hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. r (Signed)_______42___ ____________ ____ ,. -----------------------------------------------------(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 /,r ork.lyr_ ------------ ------ -------------------------------- DATE--J--*�-- --f-_4 REVIEWEDBY-------------------------------- - ------- -------------------------- ------------------------------------------ DATE----------------------- ----------- BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------- Alterationsand/or recommendations--------------------------------------- -- -- ------------------------------ -------------------------------------------------------------------------------- ----------------------------------------------------------------------- ----------- ------------ -------- -----------------------------------------------------------------------------------------------------•------•--- ------------------------------------ ----------------------- ----------------------------------------------------------------------------------------------------------- --------- ---- ---------------------------- -------- ----------------- ----------------- ------- ------------------- - -- ----------------------------•------------------------------•---------------------------------------- ------ -------------------------- FINAL INSPECTION BY:------ ^ _iarf ----------------- - Date_ zz -------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.