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FOR OFFICE USE: *� 4k ------------=------------•-------------------- IN, * ; -- ------ APPLICATION FOR SANITATION PERMIT Permit No. _ --------- ------- (Complete in.Duplicate) ` Date Issued --- -------------- -------------------------.----.---"..-- 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. JOB ADDRESS ANgLOCATiON._L ,0,. ?�r� �{�l,�g ..Q•��t,Q,l-G�icr f - � w ; / �yG Owner's Name - -----••- ------------ ��¢- ------ _--- "----- --------------------------------------------------------- Phone-------------------------------- - - r Address •--i- I - --------- --------------- - - Contractor's Nameuc.l �J j Phone. Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Numbe" living units: __�__ Number of bedrooms . __ Number of baths ""�.__ Lot size ._ �'_ ---------- Water Supply:., Public.system' .❑ Community system ❑ Private T'.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:_..__..--__..__..1 No D ' New Construction: Yes ❑ No ❑ FHA/VA:,Yes ❑ No ❑ 1 TYPE OF INSTALLATION AND SPECIFICATIONS: ice. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) - Septic ank: Distance from nearest welL_✓�_�_".__,Distance from foundation__.__(1J__�"-_".MafieriaL__��_�e________________'_______. pw No. of compartments--:__._�_-___-.-----Size_4/_ _X_�0}C_S?Liquid depth_-_ ' - Capacity-�, dG- - ---------- Dis o"s Field: Distance from nearest weli._ Q__-.-Distance from-foundation___4___-D�-_-Distance•to nearest lot lin ...........pl Number of lines-----'------- / e; Length ofeach�line �U-�'---E-----Width of trench---- --- ---------------------- iT e of.filter material_____ _ ` Yp _ .. - -------Depth.of {liter material------�-�_---;-----Total. length------1-0-�------------------------ J. Seepage:.-Pit: _ Distance_to nearest,wall _Y-------------Distance from foundation-------------!.___.Distance to nearest lot line______ _______ ❑ '� Number of pits_ `_Lining material-----f-~- --_-- Size: Diameter-----------------------Depth----------------_------_--------- I __ Cesspool: Distance from nearest well_________________Distance from'foundation_____._.__`__.___.Lining material__".-----.-------- - .___._______.___, l J� ❑ Size: Diameter = Depth -------------`--{ ----------Liquid Capacity-----------------------=---gale Privy:- Distance from nearest well__:__.-_-_- °____________________________t_-Distance--from. nearest building-------------------------------- ! i• ❑ Distance to nearest fat line- --------- --------------=----- ----- ----------------------------------------------------------- Remodeling and/or repairing (describe):-------- ----------- ------j------------- --------------------------------------------- ' .� ,.. u ; --„� k I ______-___-_•_____________________________________________________________________________________________ . e ---------------=p--.____,_ r I hereby certify that I have prepared this application and that th'e work will be done in accordance with San Joaquin County) ordinances, State laws, and rules and regulations of the'San Joaquin Local Health District. I (Signed) D and/or Contractor} ------------------------------------------------------------ ----- ---- By:._..._. 'I ----------- ------ --- --- ---- -- --- --------== :-----------ITitle} ..�. .� ----- ----------------------- (Plot plan, showing size of lot, location of,system in relate n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION BY ACCEPTED BY--- ------------- ---------------------------------------- DATE------?~_/_- REV --------------------------------- -- -------------------------- --=----- -------------------------------------------- DATE - BUILDING PERMIT ISSUED------------------------- ---------------------------------------------------------------------------- DATE------------------------- ----------- Alterations and/or recommendations: = ----------------------- --------------------------------------------- •-------------------------------------------- ------------------------------------------------------------------=------------------------- ----- ---------------- - --------------------------- ------------------------------------------- ---- ----------------'------- ------------------------------------------------ -----•----------------------------------------------------------------• ---- ---------------------------------------•---------------------•------------------------------------------- --------------------------- -- .- { ------------------------------------ ---•-------------------------------------- -------------- FINAL INSPECTION BY:-- f /h7�?_C -------------•----- Date--- --- ------ -- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Noxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy,California ES 9 REVISED 8-99 3M 3-'63 F.P.CD. 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