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FOR OFFICE USE: . APPLICATION FOR SANITATION PERMIT Permit No. - ..�. _. . -------- ------ - - -- - -----._...-------- (Complete in Duplicate) Date Issued _-------------- This Permit Expires 1 Year From Date Issudd 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. ose- 070[.s 11070 E- F-tYt•4951{ c-" C _ / JOB ADDRESS AND LOCATION_ -.. _ -...............r�_j!?L..F.. . . -.._........-._�.. --------......Q '------- ---- ... Phone.---•--'--...................... Name...._-�. ........ .... �� ---� Address-__... - y °?-J, -- '? `� J �+ ---------_......__.. 1 ..._.. . .... ._.._-----------ate' ---....._-...---------...-----------.------_ Contractor's Name......, ..................-------_............-_.------------...............-----...........-.................... Phone..............-................. Installation will some: Residence M Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -(.___ Number of bedrooms .J.... Number of baths;..... Lot size ................ k Water Supply: Public system ❑ Community system ❑ Private,);') Depth to Water Table ;3.Q.. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam,4tj Clay Loam ❑ Clay❑ Adobe❑ Hardpan❑ Previous Application Made: (if yes,date....................I No T New Construction: Yes-PNo ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well...cE _...Distant fro foundation_./.�...........MateriaL..��lyN�!..._._e___-------- goNo. of compartments----2:---------_Size t.. ..�'s❑....Liquid dopth......:! _ ...........Cepadty..l.�e �..--.. Disposal Field: Distance from nearest well_-L!�O-------Distance from foundation.._20...........Distance to nearest lot line-s......... (Zp Number of lines......,3........................Length of each line-_--,RD..-...._._._.Width of trench..A.YYn!._._._.......... jV Type of filter materieJ��' c{�i.�i..----Depth of filter material.../ ...`..........Total length---A---- ............... Seepage Pit: Distance to nearest well..............._..---Distance from foundation_....-.............Distance to nearest lot line................. y ❑ Number of pits-------------_.-----Lining material..._..................Size: Diameter-----------._.._.......Depth......................._..__.._. D nry Cesspool: Distance from nearest well-----------------Distance from foundation-----...............Lining material..._....___.------------------------- A ' ❑ Size: Diameter...................................Depth..........................................__---Liquid Capacity......................------gals. S Privy: Distance from nearest well.................---------_----.-----------_-._Distance from nearest building.._...____.__ . --_-.._._........... ❑ Distance to nearest lot line------------------ _`_-».............._...-...........-............................................................ Remodeling and/or repairing describe):................'---._.....__._......--'---..... .........................-...................................------'-------..--....................-.-................- ....................-................._'-_.__...................-............_......... ------ I hereby certify the+ I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. State laws, and rules and r ations of the San Joaquin Local Health District. (Signed)-_ ..........(Owner and/or Contractor( .. . . _ .. . .a�, -- __ _.. - - - _ - By:................._--'---'--'---..._..--..-----'-'--"--------------------------------- ------------- ' e).........------------------------.....__._..._.-_...... ' (Plot plan, showing size of lot, location of system in relation to wells, buildings, ate., can be placed on reverse side}. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._. . ..rrttrte ril.--.................................---......---..... DATE......S.` --------------_----- REVIEWEDBY........................----.........................----.....---- -------------------------------.. DATE---------------........................................ BUILDINGPERMIT ISSUED...........-...-......... - -----. ................. ---------___................ . DATE...................................------- ------ - Alterations and/or- reeommendafi ......... ... .......•-. -......... .. ... --- -----------...._.._ -- ----- ...... -'- -....... ......-'----•------ ..._....... ...........--..__...........,......--- --------........----------------.......................----............- -...... .............. ................. ---'---------------.. -....................... -- ... -----------..............................................- .................................................... FINAL INSPECTION DY:.. - -- - - - - - . . .---- ---------........ Date__ - . .-_`./-.---------------..._-------................ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haraeon A... 300 Woo Oak Stroat 124 Sycamom Slreer 205 West 9th Slreer Stockton,C.Momia Lodi,California Man1e<a,California T,acy,Colifarnfa CS 9 REVISED C-5a ]M 3-'.3 i• 4A.