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FOR OFFICE USE: ------------- --------- .... APPLICATION AOR SANITATION PERMIT Permit No. ............... ------------------- --- --- -----=------ /s"--- (Complete in Duplicate) 17 .. This Permit Expires 1 Year From Date Issued Date Issued .rc --- 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'. 10 JOBADDRESS AND LOCATION-----t:3-2.... ----- .-----------64------------------------------------------------------------••----------------------- Owner's Name----....;W ---- ---------- ------ ------ --•---------------•-------------------------------- ---- -------------------------------------- Phone--------------------•---------••---- Address-------_----------�_��,(;•------- ----------------- --------------- •----------------------------------------- •-•------------------------------------------------------------------ ••------------ ( Contractor's Name ---------------------------------------- Installation ` .: - _ --------------- Phone.------------- -- -- --- ------ - Installation will serve: Residence �i�partment House © Commercial ❑ Trailer Court- ❑ Motel^❑ Other ❑ Number of living units: ...,_- Number of bedrooms .._.9—Number of baths -----I- Loi• size --1-7.0 f Water Supply: Public system ommunity system ❑ Private ❑ Depth to Water Table 60 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy loam ❑� Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made: (If yes,date_______-------------) No [?r New Construction: Yes ❑ No FHA/VA: Yes ❑ No R ' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` Septic nk: —i Distance from nearest well-----------------Distance from foundation.........-..--,.-❑ Material._._____.......-....-----..----_----.--------.--. ------------Size--------------------------------Liquid depth------------- Capacity.-..------------- No. of compartments.............. ----- Disposal 1=i Distance from nearest well--- ---------Distance from foundation---?.q-----------Distance to nearest lot line..*S._-_--- �� Number of lines--.-4--------- _ Length of each line----.3.0_'._...........Width of trench..,.�:9c_f'._---------------- Type of filter material---.l.S(7...._._._..___-Depth of filter material---1—r-- -_-----.Total length....-.-34.................._...-.._ SeePith(� Distance to nearest well...--`....._'____-Distance from foundation---/A.__-------.Distance fo nearest iot line.-`��------_-- w p / !� f W/WJ Number of pits----- --------------Linmg material-----��.G.�:...-Size: Diameter-----�3..-.-------Deptn------ -c3-----/---------------• Cesspool: Distance from. nearest well-----------------Distance from foundation--------------------Lining material----.------------------___..__-----.. ❑ Size: Diameter--------------------- --------- ----- Depth----------------------------------------------------Liquid Capacity-_------------------------gals. Privy: Distance from nearest well------------------ ------------------------------Distance from nearest building_ ------------------------------------ ❑ Distance to nearest lot lirp-------------------------- - ----------------------------------- -----------------------------------------------...--- --------------- Remodelingand/or repairing (describe):----------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------I --------------------•------------------ -------------------------------- ----------- ------I---------------------------------------------------------------------- --------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------ -----------------•--------------------------------- --------------------------------- --------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- 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 rulVanregulati of the San Joaquin Local Health District. s (Signed) t ---------------------(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). R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------.ll - ------ --------------------------------------------- DATE---------fes ~ 2---a ---------------- REVIEWEDBY DATE-------- ---•-----------------------•---------------------- BUILDINGPERMIT ISSUED---------------------------------------- ----------- - DAT ---------------------------------------------------- Alterations and/or re��dations: ----- 1 - - ---------------------------------------- -------- ----------- ------------------------ ------� .-.. --- ---�°- --- -------- ---- ---------- --- ------------- -- - ------. ------ ------- FINAL INSPECTION BY:-- = ---------------- Date- . -------------------------------------- -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT t `� ,( t.r-.-�� 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street //f 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California l"-1 F.F.CC.