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FOR OFFICE USE: �- ----- --------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ._ _1 � ------------------ ------------ ----------------- --- --- (Complete in Duplicate) — -.--. This Permit Expires 1 Year From Date Issued Date Issued ._S___�. ---�% 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. JOB ADDRESS ANp OCATfON_ ___ ___t_- --� " Owner's Name / •X .v1-A ------------------------ - -------------------------------------------- Phone��C7.. $-/-�/, ?-- ` s Address-•--------------------- ---------/-----------�-tQ�-----•��---�--------,�.��7-`-��---f� ----•-------•------------------------ Contractor's Name IP A L-Al------ --------------- Phone_ &II&_ &.Q�_ Installation will serve: Residence A Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: _ .___. Number of bedrooms -3-- Number of baths - --- Lot size _/ -X `5---- --•--------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table go ft.4-S Character of soil to a depth of 3 feet: Sand ❑ Grave€ ❑ Sandy Loam ❑ Clay Loamy Clay ❑ Adobe E]' Hardpan ❑�� Previous Application Made: (if yes,date------- __,--------) No ❑ ,�HA/VA: Yes ❑ No New Construction; Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic T�ank- / Distance from nearest weft----_.___-----__Distance from foundation-_-----------------Material---___---.-._________.____-----_--.__.-____.--- ❑ 9X�i- ll No. of compartments--------------------------Size-------------------------------Liquid depth------------------------ -Capacity----------------------- Disposal Fiel�:� Distance from nearest well_---.._.____----Distance from foundation__.---._.__-.------Distance to nearest lot line---------------- ❑AC(`JT1X)G Number of lines-----------------------------------Length of each line----------------,-------------Width of trench Type of filter material----------------------.._Depth of filter material---------------- ------Total length-------------------_____________._____.'- Seepage Pit: Distance to nearest well_W-ff-0-E ,._Distance om undation...xar_._r__..._.Distance to nearest lot line.__X j-` �. Number of pits.tLC..>4�.(�__Lining material- --- ------ Diameter.48""___----rp -�"A i' Depth-;?- Z Cesspool Distance from nearest well----------- -----Distance from foundation._.----- -----------Lining materia)------_-..-.-----__.-.--._ ❑ Size. Diameter--------------------------------------Depth------------------------------------------ --------Liquid Capacity--------------- -----------gals. Privy: Distance from nearest well___________________ ------------------------------Distance from nearest building-----------------=----------------------. ❑ Distance to nearest lot line------------------------- ---- -------- - ---------------- ------ / - Remodeiing and/or repairing (describe}:_.. _ ___ -- .�_--___- 1 A- --------! ---•----------------------------------------------------------•--------------------------------------------------------- -- - ----•---------- ----------------------- -- ---------------------------- ---------------------------------------------------------------•------------ ------------------------------------------------------------------I---------------- - ------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St s and regulations of the San Joaquin Local Health District. (Signed)------------------------------------A-------- ' 5 _ /[1 -�-'------------ ------(Owner and/or Contractor) 8Y= '-'f�� _------ --- (Title)--. -------- ------- (Plot plan, s owing size of lot, location of system to relation to wells, buildings, etc., can be pl don reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - DATE `6 7 REVIEWEDBY----------------- - --- - ---------- -- ----------------------------------------------------------------------------- DATE ------------------------ UILDING PERMIT ISSU ---- ----------------------------------------------- - DATE -------------------------------------------- Alterations and/or recom ndations:---------------- ---------------------------•------ ---------------------- --------------------------------•- -- -------------------------------------------------------- --------------------------------------- ----------------- ------ ------------------ ---- ----------------------------•------ --- --------------------- •------------------------- ------------------------------------------- -- ----- ---------------- ------------ - - -•---- ------------- - - ---- -- FINAL INSPECTION BY: .__... 2 --- Date - SA "AOQUIN CAL 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 C.