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FOR OFFICE USE: ,. APPLICATION FOR SANITATION PERMIT Permit No. . -- ----------------------- ---------------- (Complete in Duplicate) 1I� 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 constr?tad install the work r1h,=in scribed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION../ C)--ir7'/___._ .1.s:_<_ _p'�i//=_(rO._ _f J�/�1 !�P_7_ d._- Owner's Name------- --- ------------ •C a 5------------------------------ �-r3l hone P Q - � Address �- - s---------- (---------------- ---------------------- Contractor's Name------------- s�- � ----A7------------------------------------------- --------- -------------------------------------------- Phone------- 5?-fw'� -� } Installation will serve: Residence Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ '� Number of living units. __l___ Number of bedrooms Z-_ Number of baths _,2-_ Lot size .-----/_1._ '-___.__-- Water Supply: Public system ❑ Community system ❑ Private A Depth to Water Table IS- ft. Character of soil to a depth of 3 feet: Sand &I Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: IIf yes,date---------_,----.---) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or-cesspool-permitted-cif public3ewer it-—availabit within-200-feef:)-- Septic Tan Distance from nearest well_70------Distance from f undation___ _ _.- ".Material "" 1�4 No. of com artments______Z _ .--_-Size___ G __Li uid de th____ Ca acit Disposal Field: Distance from nearest well"""?-Q___Distance from foundation___,f-.�_-.-_._.Distance to nearest lot line__Number of lines_____-___/______________ ____ _ n of each line-________-.�.1__ Width of trench---_-Type of filter material_______"..."_" ept of filter material__-._%__ ____..Total length___.__7_0-___________Seepage Pit: Distance to nearest well_-�_--D__-____Distance from f dation_____ rs___. t to nearest lot liNumber of pits Lining material ` .Size: Diameter. . .--------De th Cesspool: Distance from nearest well ____________Distance from foundation-.-._-__.._-__..._.Lining materiial__._______:____-"_." __❑ Size: Diameter------------- Depth----------- -------------- --- ---------------------Liquid Capacity-.. -------------------- ------- -------- Privy: Distance from nearest well__-_.___-_-_s�_______________________________Distance from nearest building_____._-_- ------------------------------- Distance --- ______ - Distance to nearest lot line --------------------------- ----- --------------------------- Remodelingand/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- -----•------•------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------•------------------------------ -----------------------------------------------------------------------------------------------------------------------------------------•--------------------------------------------------•----------------.".------------- --------------------------------- ------------------ ------------------------------•--------•----------------------------------•---------------------------------------------------"------•--------•----- ------ - ---- --- I hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. �Q e (Signed)_�f�t:_L._- ----------- - ------------------------------------------------------------------------------------ - --- -•-- -------- ---- --(Owner and/or Contractor) _ {Title)_- (Plot plan, showing size of lot, location of system in relation to wells, 6uildings, etc., can 6e placed on reversir'side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- -P ----------------------- DATE------- -------------3- REVIEWEDBY---------------------------------------------------------------- _.----------------------- ----------------- DATE-------------- BUILDING PERMIT ISSUED-------------- --------------------------------------------------------------------------- --------- DA-TE----- Alterations and/or recommendations-----------------------------------------------------------------------------------------------•-•-------------•----------------------------------------------- ---------------------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------- •----------------------------------------------------•----------------------------------------------------------------------------------------- ------ ----------------------------------------- ----------------------- --------------- FINAL INSPECTION ----------------- Date------ - --- ---------- --- ------ ------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California l F.P.co.