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. FOR OFFIC5•USE: , --------------- - ------------------- ----------------- / -----_---------._----- _.-.. APPLICATION FOR SANITATION PERMIT Permit No. --------------"---------------------- -----------------" (Complete in Duplicate) Date Issued --------------- -----------I------- ----.--.--- This Permit Ex '-'res i Year From Date Issued --- -- '� . I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. his application is made in compliance it Or nce No. 549. JOB ADDRESS AND LOCATION r,v-�---------�F�.- Owner's Name 1Z&jy__1`�1VA ' , -- - --------- ----------- ---- -------- Phone----••---------------...-•---------- !. Address-------- � - - 'J� 1 -1E`C1� - -------- -------------------------------------------------------------- Contractor's Name1 �1 ---------------- Phone----------------------------------- Installation will serve: Residence.� Apartment House❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -- _- Number of bathsI------ Lot size Water Supply: Public system E] Community system ❑ Private N Depth to Water Table 1 _ ft. Character of soil +o a depth of 3 feet: Sand N Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date------- No [g 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.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------Material------ El No. of compartments--------------------------Size--------------------------------Liquid depth --------------- - -------Capacity---------------------- Disposal Field: Distance from nearest wefi......`1'r`--..-.Distance from foundation-----"I-f3.-.--.Distance to nearest lot line---_s�-----..-.- Number of linesI-------------1----------- _-1-Length of each line-------- '-A-Q----------"Width of trench Type of filter material-------l -------`�'----------- ------------- e_C � .�� Depth of fifer-material------ _-,-_Total length_-----f ,U- "------------------- ' r Seepage Pit: Distance to nearest well__----".-___------.-Distance from foundation-_-----------------Disfance to nearest lot line......------------ - E] Number of pits..# = Lining material----------- -----------Size: Diameter---------- --------Depth Cesspool: Distance from*'nearest well_--r.-.-------"--Distance from foundation--------------------Lining material------------------------------------- USize: Diameter- ---------------------- ----------•-Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well.- .--.-"--_______--_-_- __ ......._Distance from nearest building-------------------------------------- Distance -------- -----_-_Distance to nearest lot line------ . i t Remode#ing and/or re airin describe _/ p 9 i ) � 7------------------------------------------------------------------------------------------------------------ - - ---- - •------------------------------ ---------"---------------•----------------------------------- ------ ------------------------- ---------------------------------------------------=---------------------------------"-------------------------------------------------- ---- --------- ---------------------------------------------------•---------------------------- ----------------------------------------------•-------------------------------------------------------- --------------------- I hereby certify that I have prepared this application and that the work will be done-ih accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. I� (Signed)------ - `�' +�� ' '"� - ---- ------ - .. -------- - --- - -----_� (Owner and/or Contractor) s By: - --- --- ---------- ----- ------ -- (Title) --- -- (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). } . - FOR DEPARTMENT USE ONLY J. APPLICATION ACCEPTED BY ------------------------------ DATE------3----- - REVIEWEDBY ------ ------ ----------------------------------------------------- -------------------------• DATE--------------------- BUILDING PERMIT ISSUED----------------t------ -------------------------------------- ------- DATE----------------------- Alterations and/or recommendations-- ----- ---------------------;.-:---- - ------- -------------------- -------------- ------------------ ---------------------- 1 ------------------------ -------------------------------------I --- -----... r ,,. -------------- ------ t ------ --- -- ---------------•-___. - .. -a--- ..._-""-'- ...---"------------------ '- '---------------.... "--- ..-.._"_�_'\�___---...-- -.-------- FINAL INSPECTION BY �1 4--- - Date - .' i� . l .. ---------- r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycarnore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California a F.P.GO. .