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----FOR O, F1 >: USE: `... 4 . T ^ � / ___.__„_______________________.__._.._..____ ------- APPLICATION FOR SANITATION PERMIT - PerJiiit. No. .. ..la 1 - (Complete in Duplicate) Date issued _.. _-_ _ _ _ _ - ---- ._ __..___..__. This Permit Expires 1 Year From Date Issued r. 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------------------- ------------- ---•----r------------•--------- ---------------------•---•------------ ' Owner's Name------ _.- � L"c Phone�7 r -` _7 p -- Address---- L� :.. = ;Y = _ = = --••------•------------- Contractor's Name......rt .____. I { + -------------- - ------ --- ------ --- ----------------------- - Phone - Installation will serve: Residence Apartment House ❑�Co�mme�cial ❑ Trailer Couh ❑..Motel ❑ Other ❑ Number of living units: . ._-_;Number ofrb edrooms `-i____ Number of maths ___ Lot size v___________________:__._ Water Supply. Public system �Community,'ysfem El Private E]' DeptJto Water Table ft. s. Character of soil to a depth of 3 feet: Sand ❑1 Gravel E] Sandy Loam ❑ iClay Loam Ej= Clay ❑ Adobe 0--Hardpan ❑ Previous Application Made: if es,`date�/;: __ -�_) -No New Construc1tion: Yes No HA VA: Yes No PP f v 3 ❑ ❑ P---FHA/VA: ❑ ❑ r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or c'esspool'permitted if public sewer is available within 200 feet.) LIN Septic Tank: Distance from nearest well________________ Distance from Joundation_._____-______.__.Material__..______.___.__.._____.______._-- i ��/ No. of compartments- Septic - ---------Size------••----- - _�,, ,; = Liquid depth ----- Capacity_ --•----------- -- Dispasal Field: Distance from nearest well.'!'__ __L)Istance from foundation-___ -------Distance to nearest lot line______________ Number of lines----------------2�_----------Length of each line___:_._ Width of trench.____yf _ of filter material____. _)_q- -r De th.of filter material_.__,/�j_.___.-Total length________ - --------------------- Type I P ,Seepage Pit: Distance to nearest well______________________Distance from foundation___________________.Distance to nearest lot line---------------_ F] Number of P g ` -------Size: Diameter----------------------Depth-----------------•--------- -Its_____________________Linin material___.__.___.__.._ - Air f C _ esspool. Distance from nearest well_________________Distance from foundation._ ___.__.____.___.Lining material-------------___.---------------------- Size: Diameter---------------------------- Depth---------- � - - -----Li9uid Capacity -----•---gals. • ❑ --------- - ---- - - - Dlstancee from nearest building •------- Privy: Distance from nearest well-------------------------------------:- ----- _-_ _ g__._-._____-__-- ---- ----------- ; ❑ Distance to nearest lot line--..--- ------ --------------------- ------ Re Remodeling and/or repairing (describe):=__ _ = ..:_ `�___� ___ -� o/_ `��_ ----------------------------------------•------------------------------------------------------ ----------------------------------------------• --------------------- -------------------------------------------------------------------------*-------------------------- ------ --•--------------------•-----------------_-------- --------------------------------------•--------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law a d rules and r gulations of the San Joaquin Local Health District. t (Signed .......... ------- ------------------- .(Owner and/or Contractor) • t BY: -----------------------------------=-- ------------------------------------------{T'itis)----------- -------- ------------------- ...- ------- ---- - i (Plot plan, showing size of lot, location'of.system in relation.to wells, buildings, etc.,.can be placed on reverse side). Y FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- -f L - ---- - ------------------ DATE--- 1-_.z ------------------- - - REVIEWEDBY--------------------------------------------- --------------------------------- ----•--------------•------------------------ DATE------------------•---------------------------------- BUILDING PERMIT ISSUED---------------------------------- - DAT ----------------------------- ----- Alteratio s and or recommendations:__?"'7" ' <_..�_.___.__ '�--- ' '��:__ r ._----'__.______- "`--'---'`t .___.__.__________ _____._---_-__ _ 1-412 `'v t�` -/----- _ � e FINAL INSPECTION BY:__ -- - ------ �� -------------- Date_--------"__C____--' , ' SAN JOAgUIN•LOCAL HEALTH DISTRICT t r -„�. a } . 4 . i 1601 E.Hazelton Ave. 300 West Oak Street 12,`x+Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8.59 3M 3-'S3 F.P.CO.