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rVx urri(-t u6t: T J y ______________ ------------------------ ------ --------- APPLICATION FOR SANITATION PERMIT Permit No. ----------------- - --------------------- --------------- (Complete in Duplicate) ------ ----- This Permit Expires 1 Year From Date Issued Date Issued Ar -^•�``_ T 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. ` !YL1 JOB ADDRESS AND LOCATION- _ __- __ ---1.c�-�1-L Owner's Name--• 1061 Q iL'�' - Phone-. � 1 -------- ------------------ Address -ill. ------- ----------------------- . 5 Contractors Name----------------------- Phone__��_� -.�o__-______�__—� �' P r ❑ Installation will serve: Residence A artment House l Commercia • ❑ Trailer Court ❑ Motel ❑ Other ❑ Number'of living units: -_ _ Number of bedrooms - ._ Number of baths --�_ Lot size _---.- ;',K Wafter Supply: Public system +Community system ❑ Private Depth to Water Table Character of soil to a depth of 34eet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: (If yes,date---------...........) No Eg-" New Construction: Yes ❑ No [A—"PHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank�'or cesspool permitted if public sewer is available within 200 feet.) � �� ( r�c� } I Septic Tank: i, Distance from nearest wellDistanc%from foundation__/--_- -- Material___ __ ----------------------------------- ________________________ _---._-- o _ No, of cmpartments-.._ -.�_. _---_---Size__'y---%z-��--�-__Liquid depth---__ -- Q© w - --------- ----�- Disposal Field: Distance from nearest weil__.tr)?f_-Distance from foundation-._;Z.0-___-.--.Distance to nearest lot line__-.----_---- Number of lines.f----- _-------_ Length of each line_--7W---?A- -r___.Width of trench-__.--��/:"____---- --_- T e of filter material__ L_ _ _�_�`� _Depth of filter material----. -.--.._Total length-----------------------Type of _ - - P ,� _ Seepage Pit: Distance to nearest well__-------------------Distance from foundation--------------------Distance to nearest lot line--____--------_.- ❑ ' Number of pits-- ------------------ Lining material----------.-----___ -Size: Diameter-----------------------Depth--------------------------------- Cesspool: ---------------------------- --Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-__----------------------------------- (N� ❑ Size: Diameter--- ------------- ----------------- Depth ------Liquid Capacity----------------------------gals, Privy: Distance from nearest well------------------ ----------------------.Distance from nearest building----------------------- ------------------- ❑ Distance to near4st lot line------------------------------------------------ - ��yy•��^ --------------------------------------------------------- ----------- GA Remodeling and/or repairing (describe):__._ i -------- -------------•---=------• -------------------------------------------------•---------- ------------ -------------------------------------------------------------- ------- 1 ------------------------------------------------------------- -----------------------------------------------------------------------------------•----------------------------------•------•-------------------------------- ------------------------------------ ----------------------- ----------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County .; ordinances&Sfe ljapdd sand egulafiions of the n Joaquin Local Health District. (Signed)---------------____-- '� � (O ner and/or Contractor) BY - .�- ---l-- -b------- ' -- {Title)-- - -------------------- Plo+ PIan, showing size of lot, locati' of system in relation a welsuildin s, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ __. -------------------------------- DATE------fj �� Gr)---------- - ------------------- -------------------- 1 ED BY------------------------------------------- - ----- --------------•-------- --- ------------------------------- -------------- DATE BUILDING PERMIT ISSUED ------------------------------------------------------------._.. DATE Alterations and/or recommendations---------------------- ------------------------ ------ r f e -----•------------------------------------------------•-- ------------------------------- - ---------------------------------------------------------------------------------------------------------------------------------------/--------------------------------------------------- FINAL INSPECTION BY:- ...................... Date------ .. -b�. ----------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.RC n. i