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rvK vrrlc_t VSt: ----------------------- --------------- ----------------- APPLICATION FOR SANITATION PERMIT Permit No. .,�C _ ._' ---- -------------------- ------------ -- --- (Complete in Duplicate) ----------- - ------------ This Permit Expires 1 Year From Date Issued bate 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 with County Ordinance No. 549. JOB ADDRESS AND LOCATION__ _ __ _ '�_�--a-�I{�� A � I��, Owner's Name------- _...1 Phone-----------•---------------• ---- Address-----• 7 , ----- ••-------------------------•-------------------•-- Contractor's Name- ---------1- Phone----------------------------------- Installation will serve: Residence ZApartment House ❑ Commercial ❑ Trailer Court ❑ Motel [❑ Other ❑ Number of living units: --I___ Number of bedrooms._ Number of baths _1_____ Lot size ____��------------------------ Water Supply: Public system ❑ Community system ❑ Private a Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay [❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---_____------------) No ❑ 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___________________ Materiaf _ ----------------------- ❑ No. of compartments -------Size--------------------------------Liquid depth---------- ---------Capacity----------------------- i Disposa Field: Distance from nearest well-----O'R ---Distance from foundation__.121K.......... Distance to nearest lot line_._!------ Number of lines-----------I----------------------Length of each line------- -QC'8.0.f7------.Width of trench---- �------------------------ Type of filter material-------- - ........Depth of filter material______ Total length-________ f j_y___----____. 1_�_�.____________________ -- Seepage Pit: Distance to nearest well_____ ________________Distance from foundation-------------------.Distance to nearest lot line__.--_._____-_ \1 ❑ Number of pits------------------ ---Lining material----f__-__.-----------Size: Diameter-----------.__---------Depfk------------------- 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 line-- --- -------------------------- ----- ----- --•------------ Remodeling and/or repairing (describe}:_.-.____ • .r ----- -- - -- ---- -------------------------------- ------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------ -- - 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)------------- . _ er and/or Contractor) 8Y� = ---- ------ - 8 P (Title) -° of plan, showing size of lot, location of system in relation to wells, buildin s etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY \ APPLICATION ACCEPTED BY--- - ----- -- -- - - - --------- DATE------- - /,/ —_�;_. -- REVIEWED BY BUILDING PERMIT ISSUED ----------------� -----------------�- -- ------------------ Alterations and/or recommendations:.__--------------- - ------------- DATE- --- ------------- ------..-------------c----------- - -- ------------------ - ----- _ -------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------- ------ -------------- ------------ ---- -------------------------------------- ------------- ---------•---------- ----------------------------------------------------------------- --•------------- ----------------- --------------------------------------- -------------------- --------- -------------------------- FINAL INSPECTION BY: Date------- - ��'� _ SAN JOAQUIN LOCAL 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.r l7.