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rvR vrrK_C uot: ---1 � --- -------------- --- - ----- APPLICATION FOR SANITATION PERMIT Permit No. ----- ----------------------------- ------------------- (Complete in Duplicate) ------- ------------------ --------------------- This Permit Exi3ires i Year From Date Issued Date Issued _9_-/ _- � Application is hereby made to the San Joaquin Local Health District for a permit to construct and insfall the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AP9 LOCATIO 4Va- �Q Owner's Name----- �` --------- ------------------- Phone--------------------------- ----•--- Address --------- ' - ------------------------------- -------------------------------------------.------------------- Contractor's Name--------- - ------ -- ----- --------------- -----. Phone----------------------------------- -------------------------- - Installation will serve: Residence WRIAparfinent House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _- -- Number of bedrooms - - Number of baths -/... Lot size - —---------- Water Supply: Public system PP Y= uy ❑ Community system ❑ Private Depth to Water Table . ft. Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Rgoo"Hardpan ❑ Previous Application Made: Ilf yes,date------------- ------) No �r New Construction: Yes ❑ No R�-' 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 -OP-- Distance from foundation-Z --- -_Mat ria .-- -- ,� - -- No. of compartments--- -A- - - -------------Sizejw� � ,�- --------Liquid depth__' - Capacity�� .. Disposal Field: Distance from nearest wet F I,�p�-._-Distance from foundation--/�__.__--_-Distance to nearest lot Iine,C�--------- Number of lines_____ -Length of each line---- _`-----_-____---Width of trench.`_____----------------- Type of filter material--/F fC�Depth of filter material--- ° -'`,___--Total length.._.5__--r__ ___ n Seepage Pit: Distance to nearest wel .?&V---_---Distance fr m fo dation__- % ---_"_Distance to nearest lot line-Y----_------ G Number of pits----�-------------Lining mate riaf- A tW .Size: Diameter-_ °_--____-__Depth-• -- *¢ Cesspool: Distance from nearest well-------------- Distance from foundation--------------- --- Lining material--..----------.__--._-_---------__.- ❑ Size: Diameter------ ------------------------------Depth_-------- ------------------ ----------- --------:_Liquid Capacity---------------------- -----gal s. Privy: Distance from nearest well-----------------------------------------------.-Distance from nearest building Distance to nearest lot line------ Remodeling and/or repairing (describe):---------- 4� •r 4 ----•--------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 rules and regulations of the San Joaquin Local Health District. (Signed-- �. ------------- r Contract By:------------------------------------------ - - (Title)- o (Plot plan, showing size of lot, location of system in rel n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY O.P -------- DATE------ - G -------- REVIEWED BY DATE----------------- -------------------------------------------------------------------------------------- BUILDING PERMIT ISSUED-------------- ---------------- - DATE--------- --- - Alterations and/or recommendations:----------------� .� ---- C f�i - � GsrC��.._1�zo. r A `-'- -------- � . - � - - ------------------ ----------- -- ------------ -------------------------I----------------------- - FINAL INSPECTION BY:...... _--.-__-------------------- �r�-� " - ---------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Naielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.F.Ca,