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/Q �--OFFICE USE: --------------- --------- ________________________�- APPLICATION FOR SANITATION PERMIT Permit No. . l,�� ---------- - -------------------------- Co - ( mplete in Duplicate} - This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal! the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN OCATION_..___ _ ._.a�.L------------•----------,------------------------- ----------------------•-- - --------------•------------------ Owner's Name -------•--- Phone-- ---------- --------- a r Address------------ - --------- Contractor's Name___ Phone_.L�G - � -•----------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _ Number of bedrooms -- Number of baths -- - Lot size ___--tea-- ,2�7 -------------------------- Water Supply: Public system (P- Community system ❑ Private ❑ Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Er Hardpan ❑ Previous Application Made:. (If yes,date........... ........) No [D—New Construction: Yes ❑ No Q�FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ftd: Distance from nearest well -Distance from nearest well----------- ---Distance from foundation_____-_______----_.MaterialNo. of compartments-- ------------------- --Size----------------- t------------Liquid depth - Capacity ( ,_ - --Distance from foundlD_-_____--.Distance to nearest lot line.-___�_� N. ation, ___ [[ Number of lines___.----/--_ ____-_ --Length of each line-- ------------- _ __ --.---- .Width of trench-...__ .._ �_ _____`________ `C Type of:filter material---S!_ ' ---Depth of filter.material____`8_____-----Total length___-_____ya________________________ Seepage Pit: Distance to nearest well_._�__f_-�----__._Distance m foundation----45?D____-_.Distance to nearest lot iine..-__s_____- ©� Number of pits---.-_�------- -- Lining mate ria l__ Q- / _.Size: Diamete r.-.._ -3_-- ------Depth----a�_Sf------------- ---- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-.____---__.._-----____--_ ❑ Size: Diameter-_--- ----------- -=--------------- -Depth------------- ------------------ ------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-----------------------------------______________Distance from nearest bu;idin El ' [);stance to nearest lot line,____.....________________ Remodeling and/or repairing (describe):------ ------------------------ ------------------------ -------- --------------------- -------------------------------------------------- -----------------------------------------------------------------•------------------------------•-- ------------------- I hereby certify that i have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, vte laws, and rules and r gulations of the an Joaquin Local Health District. (5i ned 9 )----------------------- --------- ----- ---- ---- ---- '------------------------ -- -_(Owner and/or Contractor) By:--------------------------------------------- ------------- -- --- ---- --- --�•-r-- L -------(Title) �f (Plot plan, showing size of lot, location of system in relation to wells, uildings, etc., canbe placed on reverse side). ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- = --------------- ------ DATE------->-51 - - REVIEWED BY------------------------- --------- - ----------- DATE - -- - -- - -- ---------------------------------- BUILDING PERMIT ISSUED-----------1-------------------------------------------------------------------------- ------------- DATE Alterations and/or recommendations------------ - ----------------- -�A� ' A----------44 f? R.------ ------------- -------------------------------------------------- - ----------------------------- --------------------------------------------- ----------------------------------- - ---------------------------------------._---------------------- ----- ------------ -----------------------------------------------------••--------- FINAL INSPECTION BY--------------------c _.--------- - ' ------------------- --- Date-------- 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.ca. f f