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rUK UrrIUE USE: - --------- ------------- --------------.--------------------------/(,".-?V- APPLICATION FOR SANITATION PERMIT Permit No. _ d..- - s•- -------- -------- ------------ -------------- - ------ — (Complete in Duplicate) .............. This Permit Ex fres 7 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 descried. This application is made in compliance with County Ordinance No. 549. N JOB ADDRESS AND LOCA !ON__.__. 019__�- ---------------•--------------------------------------------------------I------------ Owner's Name r= ----- Phone----- --------;;0 �_.� ._�IQ • � - --------- ------------- ----------- --- _ . - /s --••---- ------------------------------ • { Contractors Name 7 ,- ----- ''------------------------ Phone-- I Installation will serve: Residence Apartment House ❑ Commercial (]' Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: __/____'Number of bedrooms _ ___._ Number-ofr - �- 7 1 -- —r/7,' r!?aths __- Lot size ____.v2 Water Supply: Public system [7!Community system ❑ Private ❑ Depth to Water Table 0 ft. Character of soil to a depth of 3 feet. Sand E] Gravel E] dpan Sandy Loam ❑ Clay Loam❑ Clay ❑ Adobe IarEjr Previous Application Made: (If yes,dote____________________) No P` New Construction: Yes 0 No;�F}-IA/VA: Yes ❑ No [ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well________________Distance from foundation_`_----------- 'Materia l------- ..-___...__-_______-__.._ ----------- No. of compartments- ---- - ---------------Size--------------------------------Liquid depth----------------- ------Capacity--------- ------------ Disposal iei : Distance from nearest well______._. Distance from foundation.-_/4 ------- Distance to nearest lot line f..____ Number of lines_ -------------- Length of each line_-�d' k__------.Width of trench.---oZ_g-_-'--_--___---_--- Type of filter material-_.._1.3�._5'!�----.__Depth of filter material -�rTotaI length----:_-7d-'_ •� I _ Seepage Pit: Distance to nearest well______ ---------Distance from foundation---- -_`_-------Distance to nearest lot line_` --------- - F ------Linin material.__--, ---Size: Diameter---3 `-----------Depth_... '---------------- S Number of pits..Il g Cesspool: Distance from nearest well-----------------Distance from foundation--------------___---Lining material____.-__---------..___._____-___._._. ---------Depth----------------------------- ----------------------Liquid Capacity---------------- ❑ Size: Diameter.-- -----------gals. Privy: Distance from nearest well---.--------------------------------------------.Distance from nearest buildin ❑ 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 and regulations of the San Joaquin Local Health District. (Sighed)_________________ ------------------------------------------ and/ Contractor) BY (Title)--------------- --_---------------- --- ---- -- ------- - ! (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED REVIEWEDBY------------------------- ------- ---------- --------------------------------- ----------------------------------------------- DATE BUILDING PERMIT ISSUED------------------------------------ ------ DATE Alt insan tor. commen attons_______________ ---- -- --- ._ --------491W__ ' - ------ ---------- - ------------- ------ --- FINAL INSPECTION BY: .------- --- -------- Date....... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 F,Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.RC O.