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FUKOFFICE USE: --- -2----- APPLICATION FOR SANITATION PERMIT Permit No. G------,------�-'To- ----- (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 with County Ordinance No. 549, JOB ADDRESS AND LOCATION-__ � �P.. __..------------------------------------------ Owner's Name /�++ CrG_.'- -------------- Address-----, ---------- - - --- ------ ------• --------------------- ------------------------------------------------ Contractor's Name----- Phone..elolg'-_31 elL_ --- -- -------- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot size __.. Water Supply: Pubiic system Community system ❑ Private ❑ Depth to Water TableyJ_" ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Piardpan ❑ Previous Application Made: (If yes,date------------------- No New Construction: Yes N---N'. ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if ublic sewer is available within 200 feet.) Septic Tank: Distance from nearest well___Distance from found tion_. _ ��+____- �� ------.- Material--------- -- ---- - ---- ------- __.--Size- No. of compartments -----Liquid depth_ ....... CapautY Disposal Field: Distance from nearest welh0rkut.._Distance from foundation.. .. - + d_---------Distance to nearest lot line . ...... Number of lines.._._/_________ ---Length of each line........5.17v_1----�� ".Width of trench--------- _�/..___. _ .- Type of filter material- - _,d.0 _..Depth of filter material_._ �_10__------Total length---__. �-___-•"--__ 'y� Qi i Seepage -it: Distance to nearest well_-*--/�r�__Distant om foundation_____ ____.Distance to nearest lot line--_ Lel Number of pits--___-�-.------- .__Lining material- Q -�----Size: Diameter-- ---- --.-----Depth-_---__;.?..-. ------------ 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------------- ------------------------- El - ----__❑ 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 County ordinances, State laws, and rules a d regulations of the San Joaquin Local Health District. (Si ned n 9 }---- - ------------ ---- - --- ---- -- ----------------------------------------------- (Owner and/or Contractor] BY: -- ---`--`-� "---------------- ------(Title) - -.. - --------- ----------------------- (Plot plan, showing size of ]cit, location of system in relation t ells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------_---------- .- -------- r 6 REVIEWEDBY------------------------------------------ -- -- --------------------------------------------- DATE - ---------------------------------------------------------- BUILDINGPERMIT ISSUED---------- .--------------------- _-___-___--_-__-__-__________ _._ __________...-_._._.___,__.____. DATE -r-�----- { Alterations and/or recommendations:-.____. --- - - - ... `y�� "._-"............. --_ .---. ""'r ..f.___._-i-_ _ ----------------- FINAL INSPECTION BY:............ �� , . ----- ------------- Date-------- - -------- - ----- ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelfon Ave. 300 West Oak Street 724 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.F.Ca.