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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .............._....... (Complete-in Duplicate) Date Issued .. "7�7y• 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 application is made in compliance with County Ordinance No. 549, 1�!!!'ft^...!' ''� ........1... <y. `-.................................................. JOB ADDRESS AND LOCATION_.._ �3.a..�...G.c% Owner's Nam ../�J jr _.. ...v..�....Y..-..,a. ..-. .... ...... . �<< Phone .......................... ............._........................... cr........ .-............................... Address......... Contractor's Name..... C1� _ ............. .....__ .. .... .............. ........... Phone.................................. Installation will serve: Residence Apartment House ❑ Commerciel ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .. Number cf 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 [Er--Gravel ❑ Sandy Loam❑ Clay Loam❑ Clay❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,dote. I 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 k: Distance from nearest weil.,/GV f .Distance from foundation.. /.2�. _. Material Cr-� � No. of compartments .. Size.............. ...........Liquid tiepin Capacity—FVC)...'..... r Disposal Field: Distance from nearest well !L�' 4 .D stnnce from foundation...xJ ...... .Distancr to nearest lot line................. [� Number of lines _...•Z. L Length of each line..2.TO.�3r... . .Width of tren6. ....2.......... ............. �fK�' Type of filter materiaLS14` GI. .Depth of filter material . /.y. Total length.. .. V ........................... Seepage Pit: D;stbnce to nearest well Distance from foundation...................Distance to nearest lot line................. N ❑ Number of pits Lining material... _. _ Sue: Diameter. Depth . .. .. ,J Cesspool: Distance from nearest well _..... ... -Distance from foundation Lining material.. ................................ ❑ Size: Diameter. Depth. — _ .. . . Liquid Capacity. ........................gals. Privy: Distanco from nearest will Distance from nearest building. . A ❑ Distance to noarmt lot lino .. .'... ..." Remodeling and/or repairing (doseribe): AL,lli!"" -�4'^r..... �• } .......................... .. .... . .... . .. ..... . .... ................................................. .. .... _ .........I............... ....... ..................... . . . _.. ..................................... .. ................... .... .... ............ ..I . .. . .. ..... ...... . I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed..W... / 1 / - (Owner and/or Contractor) .. . . % (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.. 7..Y.......................... REVIEWEDBY... ...... .. ...... ...................... DATE.......................................................... BUILDINGPERMIT ISSUED........ .. .. . .. . . .. ....... . .......... ... ........ ........ DATE.......................... ................................ „ . Alterations and/or recommendations: ... ........................................................................................................ .. . .........._.. _. . .. .. ................ ........................................................................................... ... . .......................... ... .. .... .. .... ................................. ................................ ` . . ................ . ... . ......... .. ......... .......................................... FINAL INSPECTIONBY: �� Date Z. �.�!..-..7 (� '� ._.tCr ................................. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hatellen Ave. 300 Well Oak St,est 124 Sycamere Sheol 205 West 016 Street Stockton,California Lodi California Manlece,California Tracy,California E.H.9 2M 1.67 VonQuard P.eu