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APPLICATION FOR SANITATION PERMIT Permit No. .2�. _ __ ...... .. .- -- (Complete in Duplicate) Date Issued L1/t`f _G This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This (icat'on is rade in c m I' ce w' h County Ordinance No. 549. % JOB ADDRESS AN L-OCATIO ` --__ -- - �' -- � -------------- Owner's ------------ Owner's Namor -�- C --------- Phone -- --------- Address r 7 - ------------ Contractor's Name----------, --------- ------------------- --------------•-- ------- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I--- Number of bedrooms—e-_.. Number of the Z____ Lot size ---.�._-�1�r,':%�------ .._... -------------- Water Supply: Public system E] Community system E] 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 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well-.670---- Distance from foundation-_. _ No. of compartments------Z)_-----------Size._ y _ ... 11'-__Liquid depth_.... ---------Capacity-,/ ._-_ Disposal F' Id: Distance from near well_}----------Distance from foundation_-ZDivnce to nearest lot line- _____-_. Number of lines___._ / Length of each line---__ j%Or idth of trench. . �/ Type of filter material_-__ ____ �;V �__�epth of filter material___--- —______.Total length---_c ----- Seepage Pit: Distance to nearest well-----_________________Distance from foundation--------------------Distance to nearest lot line.---.___-_---.-.- ❑ Number of pits.....................Lining material.___ ----------- Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----------._---------------___--- ❑ Size: Diameter. .- ------------- ----------------Depth-----.---------------------------- -- Liquid Capacity----------------------------gals. to Privy: Distance from nearest well..................-------._.---------------------Distance from nearest building------------------------------------------ F] Distance to nearest lot line------ ----------------------- -- �_ Z ------------------------------------------ ---------------------------------------------- Remodefin or repairing (describe)______________ ______ �'�{'�__`.______C. f'_�,YJ �1 '=__------_----_-_--- < ---------------- •---•--------------------------------•----------- ---------- -------------------------------------------- ------------------------------------------------------- ---------- -------- - - - - - ------------------------------ -- ------------•---- ------------------------------------------- - ------------------------------------•------------------------------ - hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I and rules and regul tions of the San Joaquin Local Health District. (Signed)------- ----- ---- -- - --- -f---------- -- ------- By: - - (Owner and/or��ontrac ) By:--•------------------ - - (Title) (Plot plan, showing ' e of lot, location of system in rela to o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__.__ _______________ �f _ DATE__.-�'L REVIEWEDBY------------------------------------------------------- ------ -------------------------------- ---------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------- ---------------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations------------------------------------------------------- -------------------------- -----------•-•-•-•--•--------------•--•--------------•---------•------------- --- ------------------------------ ---- - ------------------------------------------------------ ------------------------------------••---------------- ----------------------------------------------------------------- ----------------------- ---------- ------ ------------------- ------ ----------- -------_---------------------------------- -----------------------------------------------•--•------------------•-----------•---- FINAL INSPECTION BY:. _.- .. ��L ------- Date_1__..C?.-_--V 7-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 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 C.