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FOR OFFICE USE: �- ------------------------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. l ------------------ ------------------------------------ (Complete in Duplicate) --- --. This Permit Expires 1 Year From Date Issued Date Issued :ii_�_`_R: =. � Application is hereby made to the San Joaquin Local Health District for a per it to construct and install th ork *ein described. This application is made in compliance with County Ordinance No. 549. T JO$ ADDRESS A LOCATION_ -�._?_�' ,� r� t�^ra�•�-tel. f 1 �� s• Q - •--------------------••------- Owner's Name_________ __ Phone -------------- Address------------------ ��l Com•- - - - -- -- --- -- ----- ----------•-------------------. - ----------------------.......... Contractor's Name• f ------------•----------- ---------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other p Number of living units: __/___ Number of bedrooms _Number of baths ---- Lot size _____�'_____.__.._ --------------------------- Water Supply: Public system ❑ Community system ❑ Private [/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 ❑Ax TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi ank: Distance from nearest well__!-9!�'r----Distance from foundation____6d_r_-___".Material___.'______________ No. of compartments--------- 77�-.-- --Size- -F ..x iX Liquid depth----.-1�t- _. ----------Capacity--/ z� -- 4 Dispos Field: Distance from nearest well_2i`___"--Distance from foundation---Z d`------Distance to nearest lot line- "__ __ P76 Number of lines--------Y_.__.----_--------Length of each line------S--d__--------------Width of french----;?�__�-.____-_-_ . _ ............ R - - -------- Type of filter material------_`_..__ Depth of filter material. ---1,4.___`____.__Total length----f 0 Q-_'_______-.__"-__________- Seep e Pit: Distance to nearest well_____/.4�0--�"-__Distance from foundation S _ ______________Distance to nearest lot line_.'-_________-.. Number of pits._.___-y-------Lining material----�'_'-f�._,____Size: Diameter ,, -- -_--.Depth_�S"--_. -_ Cesspool: Distance from nearest well--------------___Distance from foundation.._--_--._.._._.Lining materia!__.- --------- ❑ Size: Diameter --- ----------------""----------Depth------ ------------------------------- -------------Liquid Capacity-------------- -------- gals. Privy: Distance from nearest well___________________________ ----------Distance from nearest building ❑ Distance to nearest lot fine-- ------------------------------ ----------------------- ---------------------------- Remodeling and/or repairing (describe):---------------- ------- r� ------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------- ----- --- ---------------------------------------I-------------------------------------------------------------------------------------------------------- = I hereby cer 'fir that 1 have prepared this application and that,the work will be done in accordance with San Joaquin County ordinances, St e I�s, and rules and regulations of the San Joaquin Local Health District. {Signed) ----------- ----- -- - --- - ------ - -- $. er and/or Contractor) -------------------------------------------- ------- -------------------------- $Y� ------- ------------------- - - -------------------------------------------------(Title)------_ -------------- - (Plot plan, showing size of lot, location of systeifin relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ ---------------------------------------------- ----- DATE_-el- REVIEWEDBY----- -------------------------------------------- ---- ----- bA7E- ---------------- $UILDING PERMIT ISSUED ------------------------------------------- ----------------- DATE-------------------------- Alterations and/or recommendations:-_.._"..____.-_-_____..-__-"_----------- ------------------------------- ""----"-------__••__"---.- --------------------------------------- - ---- ------------------------------------------------- --------------------------------------------•----- -------------------- -------------------------------------------------- ------------ -------------------- j - ------------------------ - - --------------------------------------------------- ----------------------- ------------------------------------------- -------------------- FINAL INSPECTION BY:..,,,A9 y -------- ----------- Date 17 SAN JOAQUIN LOCAL HEALTH DISTRICT 7601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C P. r