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rurc urri+vt ubt: -------------------------- 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 described. This application is made in compliance-w,ith.County Ordinance No. 549. if: s.. µ ^,. . JOB ADDRESS AND L CATION_ _____ _.ra;ct -_ " ---- ---- -- ---- - ------- - Owner's Name----- -' p ------ Phone--- Address---------- •46O Contractor's Name_____""•"" fr `.mac`moo-`a..._ �` ------•-------. Installation will serve: Residence "V ®'�partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ �,, Number of livingunits: __.___-_ Number of bedrooms __ e�Q ' ,Y / p/ q i -_- Number of baths -- Lot size __________-_-____"""--- -•- Wafer Supply: Public system ❑ Community system Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand gavel [Sandy Loam ❑ Clay Loam El Clay ❑ Adobe ❑ Hardpan ❑ (� Previous Application Made: (if yes,date--------------------) No ❑ New Construction: Yes 9?-!`�o ❑ FHA/VA: Yes ❑ No x TYPE OF INSTALLATION AND SPECIFICATIONS: »" ii-(No,septic--fank•or.-cesspool-permitted+ifspublic=sewer-is:available-withiri 200-feet) Septic Tank: Distance from nearest well-- Distance from foundation___1Q--------- _ Material___.__ No. of corripartm ---- ents--------- -------------Size---- 1Xg--------_---Liquid depth----------IV701---------Cepacity--- --/.-�v Disposal Field: Distance from nearest well—n-0 -"Distance from foundation-----1-`C>-01----- Distance to nearest lot line----------------- ------------ Type ___'z _-___ F ❑ Number of lines_:_--_.._._�jl_-t�-----------Length of each line--- a �f b�S.Width of french._.__..-_L' Type of filter material__-�� epth of filter material-/�� /-"_Total length____ : /$-•"""" -------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line___--._____._____ ❑ Number of pits- I-------------------Lining material-----------------------Size: Diameter-------------- -- -----Depth----------------------- Cesspool: Distance from nearest well_________________Distance from foundation ------------------ Lining material----._---------------------.......... ❑ Size: Diameter----1--- ------ ---- Depth----------------------------------- ----------------Liquid Capacity gals. Privy: Distance from nearest well----- ------------------------------------- --Distance from nearest building ------ -------- 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 Counfy. ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)------ C— ` - -- ------ } - - � � --------- �------------ ------- -------- --------- ------ - --------------- Owner and/or Contractor) 0 or [Plot plan, showing size of lot, location of systerfi In relation to wells, buildings, etc., can be placed on reverse side). } FOR DEPARTMENT USE ONLY APPLICATfON ACCEPTED BY- REVIEWED Y-_-- _.-= DATE------ = - -----_-""-- --- ------ ---------------- EVIEWED BY----------------------------- ---- = - - -- DATE ---- - UILDING PERMIT ISSUED-----•-----------�--- - ---- DATE------------------- --------- - Alterations and/or recommendafions: � � r ---------------------------- -------- - -------------------------------- --------------- ---------------- ------- AA ----- ------- - ----------------- ---------------------------------------------------------------- - FINAL INSPECTIO ------------ Date------- lao ----- ------------------------------------ OAQUIN LOCAL HEALTH DISTRICT . 1601 E.Hazellon Ave. 4 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Cq. k