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FOR OFFICE USE: y � ------------------------------- ------- - -- - ------------ - -------------- ------ 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 Count Ordinance No. 549. i Z JOB ADDRESS AND LOCATION -4-pa"- - � Owner's Name---------115-!s-l1.----- ----- ---------- ------- ---------•----------------- -------- ----------- ---------------- ------ Phone------------------------------------ Address-----------?-0-pe_- M-71 ------------------------ ---------------------------------------------------------- •------- ---•----•-•---------------• Contractor's Name-.- ---------------------------------------------------------------- Phone---•--..------_----•---•---------- Installation will serve: Residence Ia Apartment House ❑ Commercial ❑ Trailer. Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms A--- Number of baths �- Lot size -----_______--_.Y---------------------------------------- � Water Supply. Public system ❑ Community system ❑ Private Kj Depth to Water Table 6-.D-- ft. Character of soil to a depthji of 3 feet: Sand ❑ Gravel ❑ Sandy Loam EA Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ S Previous Application Made:11 Ilf yes,date------------------ -} No ® New Construction: Yes N No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I Septic Tank: Distance from nearest well---S-Q-------Distancq frofoundation-------IV-------Material----CID - ------------------------ NNo. of compartments------- ------- ----Size-! n- -Ak.4_�_____Liquid depth----1-4------------------Capacity----(_'4__i7"_0----- Disposal Field: Distance from nearest well_S"_0 -_-_Distance from foundation----tA— ------_.Distance to nearest lot linea`+_............. Length of each line--_-_- O' Width of trench_'1-:`f:?'-------------------- .-- Number of lines---------- ------- g Type of filter material-- '_.'S--------------Depth of filter material----AAI--------------Total length__.�14'------------------------ Seepage Pit: Distance to nearest well----------------.----_Distance from foundation--------------------Distance to nearest lot line-__--..---.__-.- �- ❑ Numberrof pits----------------------Lining material----------.------------Size: Diameter-----------------------Depth---------------------------_-_--- Cesspool: Distance from nearest well-----------------Distance from foundation---------------------Lining material---------------------------.-_.------. N ❑ Size: Diameter------- ------------------------------Depth---------- ---------- ------- ------- -------------Liquid Capacity---------------------------gals. ....Distance from nearest building Privy: Distance from rom nearest well-- -------------- -------------- - 5 --------- --------- ---------------- ❑ Distance to nearest lot line------------ -------------------- --- ------------------------------------------------------------------- - I it 'i Remodeling and/or repairing (describe):------- -------------------- ------------ ------------ --------••------ ---------------------- -----------' ------- ------------ -------- ----- -------- ------------- ----------- - -•------------------- ---------------- -------------- ---------------- I hereby certify that l have prepared this Ap lication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and ruLws and regulat'6as of the San Joaquin Local Health District. (Signed)---_ 7/ - �rf �J, h -. ------------------- ------(Owner and/or Contractor) , Title - �(Plort 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-----a _! . - .' ------- DATE--A1- ' REVIEWEDBY----------------------- --------- ---------------- ----------------------------- ------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------- -------------- - ----------------- -----------------• DATE------------------------------------------------------------- Alterations and/or recommendations--------------- ------ --------•---•---------•-•------•-------•------------------------ --- ---------•--------- ------------------------------------------------------------------------------ FINAL INSPECTION BY: A f,' Date-.-: ------------------ -------------------- -------------- r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracyr California