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FOR OFFICE USE: ._____________________________________--74 _-J APPLICATION FOR SANITATION PERMIT Permit No. ....�� ----- --------- -------------I----------- -------- -- ► (Complete in Duplicate) ' I i This Permit Ex fres 1 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 a p p lication is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION__---- L� ------------------ ------------------•- -•-------------------------------- Owner's Name------- _ - Phone-- Address-------7.3_ - ' _ - ----------------------------------------------------------------------------------------------------------------------------------------- Contractor's Name ----- ------------------ Phone------------------------------ Installation will serve: Residence O—Apartment House ❑ Commercial [❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I---- Number of bedrooms-3__- Number of baths __/_.._ Lot,size 149A X-f a s Water Supply: Public system M—Community system E] 'Private ❑ Depth to Water Table X-Oft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [3--Hardpan ❑ Previous Application Made: (If yes,date________________ ) No la, New Construction: Yes 1p�"1No ❑ FHA/VA: Yes ❑ No E!9— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _ Septic Tank: Distance from nearest weli__1_------Distance from foundation fQ-..__.I-_---Material__', --- _�- No. of compartments_..__' ----------------Size___3X6-X-,9--------Liquid depth----1__`---_----------Capacity....e4�qg__--f Disposal Field: Distance from nearest weal__ — Distance from founda#ion_L�___-_-_T-__...Distance to nearest lot line_`'_.__._. Number of lines________ ____________________Length of each line___7S`__.__---[----.Width of trench_._ Type of filter material__ �± ---------Depth of"filter material_" b'""`"` ___--T fa l length___._�.S" --------------_------- Seepage Pit: Distance to nearest well----'-r--.----_Distance from foundation l ___!____..Distance to nearest lob line _47?�___-_� Number of pits....''------------Lining material_._ )_?Pt f Size*: Diameter_ Z3_"-..._.Depth -- __._'_____-_______ ., Cesspool: ,Disfanc6 from nearest well-----------------Distance from foundation------------- .....Lining material--.-----------------------------------Z .=tom .❑ Size: Dimeter------------------------------------- - - �-------------------- --- ---- -=- i; ---- Liquid Capacity-------------- ----------•-gals. Privy Distance frorrI nearest weft-_.______ ____ _.___.____..._-Distance from nearesf building--_____---._-.-___.--____ a w. _ - ❑ � Distance to nearest lot line--------------------------------- --- - ----- ---------- ---------J-r----------- ,----------- " Remodeling and/or repairingj(describe):-----------------------------______ --•---,----------------- -------------------------------•---------------------------------•------------------------• ------------------------------------- i ------ --------- iI ------------------------------- Amer!--gar � _____________________________________g_.________�. ____.____.____..__________________ _..________.____________________._.________.________------------ __ } _____________ ______________________ ________ I hereby certify that I have prepared this application and that the work will be done In accordance with San Joaquin County ordinances, tate laws, and rules and regulations of the°San Joaquin Local Health District. d (Signed)-------- ----- I-- ------------------- 4 - (Owner and/or Contractor) f Y •,---------------- = -- ---------- -:----------------------------------------------------(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------ � fI---d.f- -------- -------------------- REVIEWEDBY-'---- --------------------- --L----------- --------- -- ---- ----- DATE ----- -------------- UILDING PERMIT ISSUED------------------------------------------------------ ----------------------------------------------- DATE--------- --------------------------------- - AI raft sand/or ca ndatio s:_____...______._... __ } --------•�-�--- - --------------- -- � ----- ------------------- -- -------------- --- - - - --•----- ---- - .--- ------ -------------------------------------------- FINAL INSPECTION BY:_.. -------- -—----------------------------- ------ Date--............. SAN'JOAQUIN LOCAL HEALTH DISTRICT 1601 F.Noxelton Ave. 300 West Oak Street 124 Sycamore Street 20S West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California Y