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FUR C)FFICE USE: ------------31 {j --------------`-— -e ---------------_----_------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. 0-3_.fJ__ ---------- ------------------------------------ -- - -- (Complete in Duplicate) ---------------- ----- This Permit Expires I Year From Date Issued 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 application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOC ION 7.- �/' -----------------------------------------------•-•-------------- Owner'sName -tr-�.------------ -------- -------- ----------------------------------- ------ Phone-------------• ---................. Address- ----------- Contractor's Name--- _tZo----�---------5----- ••------------------•----- Phone..--------------------------------- Installation will serve: Residence �Apartmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __-(____ Number of bedroomsNumber of baths J_.__ Lot size ____7�A _/'0 ------------------------_________ Water Supply: Public system 21--community system ❑ Private ❑ Depth to Water Table 4;-6'- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe`(T'Hardpan ❑ Previous Application Made: '[If yes,date---._----------------} No ®' New Construction: Yes [5'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 nk• f Distance from nearest well_________________Distance from foundation_____________ _.__.Material__..-----------------------------------_.______- �J No. _of compartments------ -•-----------------Size------------------------------..Liquid depth-------------------------Capacity----------------------- f Disposal F Distance from nearest well.__.—____._.Distance from foundation--- f?------------Distance to nearest lot line__ -7- 9 �p i--- - -- ---------Width of french._-2-Q--- y------------------ U Number of lines_________________ ______ ____Len th of each line_ Type of filter material____J�'C--4__:__ ..___Depth of filter material__�_y_`_____.__..Total length___.__3p_____________________________ Seepage Pit: Distance to nearest weft----_ ---------_---Distance from foundation_.l!�-------------Distance to nearest lot line---- -------- Number of pits___.1----------------Lining material___ 1__?XX....Size: Diameter______32_G__--.Depth..___.�d_ :�-__J___..___--__ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----------.____.__.__..__--_-_______- ❑ Size: Diameter--------------------- - ----- -------De th------------------------------ - -- --- -------Liquid Capacity- -------------------------gals. Privy: Distance from nearesf well-------------------------------------------------Distance from nearest building--------------------------------------.._. ❑ Distance to nearest lot line ----------------- -----•--=-------------------------------- -------------------------------------------- ------------------------ Remodelingand/or repairing (describe):----------------- --------------------------------------------------------------------------------------------------- ---------------------------•---- a ,,. . _-. . -----------------------------------------------------------•-•-------- ------------------------------------------------------------- ------------------------------------------------------------------- ---------------- I hereby certify that I have prepared this.applicafion,and that the work will be done in accordance with San Joaquin County ordinances, Statelaws, and rule an regu ations of the San Joaquin Local Health District. x {Signed}________ ______ ------------------------------------------------------------- ----------------------------(Owner and/or Contractor) f By: M ' (Title) ------------ ------- ------------ ---- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY........... / � ''�. ------------------------------ DATE------- REVIEWEDBY----------------------------------------- ------------------------------- ------------------------------------ --------- DATE------------------------------------- ----------------- BUILDING PERMIT ISSUED---------•------------- ------ ------------ ------ DATE--------------------------------------------- --------------- Alterations and/or recommendafions:----- ----- ------------------------------------------------------------------------------------------------------------------ ---- ---------------------------------------------------------------- ------------------------------------------------------------------------------------------•---•------------- -------------------------- ------ + � FINAL INSPECTION BY:. , e- --------------------------- Date----------- SAN 1Krj(YAQ'UlN ---------SAN1KJOAQUEN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street k 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California r.p-c o.