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% FOR OFFICE USE: �. �;':M ,. -- ------------------------ -------- -- Permit No. �4.. __' .3. 7 APPLICATION FOR SANITATION PERMIT ------------------------ --------- AI/ ----------------_--_______- (Complete in Duplicate) bate Issued -�--.--------- ----- `s' This Permit Expires 1 Year From Date Issue 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. r 1 JOB ADDRESS AND LOCATION.._--- ,l°EG .-------- ` °`" -----------------------------------� - -------------------- Owner's Name.----- `�-----`'� ' ----------------- -- ---------------------------'------------- Phone-- =- S----7.7 _ 4 , -----•--------------'----'--------------------•-------'------ Address �Q/d -L�� t� =t7d -- Contractor's Name__4:� ------ r •----- - Phone -----•---------------- Installaticn will serve: Residence Apartment House ❑ Commercial ❑ 'Trailer Court ❑ Motel ❑ Other ❑ Number of bedrooms _"."_ Number of baths -� Lot size _"."""""""_ -"__"" Number of living units: � � """"� Water Supply: Public system E] •-Community system [-] Private X Depth to Water Table -------- ft. Character of soil to a depth of 3-feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Df Hardpan ❑ Previous Application Made. +(If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic Tank: Distance from nearest well----s. ---Distance from foundation------r¢------.Mat�ial_ ---- -.- c-- Li uid de th --rte Capacity No. of compartments---------�---------.-Size----`-?'"X-P_.--------- - q P. - Z --------- _ Disposal Field: Distance from nearest well--__S Q._Distance from foundation""""-__� ----.Distance to nearest lot line_"--' Number of lines-----------/---------------------Length of each line-------9b---------------Width of trench-----�------------------------ _`Depth of filter _ mate ria -.--.Total length--_---9_P- ------------------------- Type of filter material _" Seepage Pit: Distance to nearest well-.--- !"4'_ _---Distance from foundation------AO?------Distance to nearest lot line----------------- O' If Number of pits--------- ----------Lining material----- om.------Size: Diameter.------- De th----' 1- p� Cesspool: Distance from nearest well-----------------Distance from foundation------------.-------Lining material_..---__.---_----.-----------------. ❑ Size: Diameter---------------------- --------- -Depth-------------------- Liquid Capacity gals. Privy: Distance from nearest well_---------------- --------m------------------ -Distance from nearest building-------------"-------------------- --"--. ❑ Distance 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 y' ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Ow_n_ /or Contracter) (Signed) � - - --- Tale I - - - - - ------------------------------------ ---- --------------------------- -------( � )-------------- ------------------ -_ - 1 (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 =------------------------ DATE f' '--- REVIEWED BY_*L DATE----------------------------------=------------------------ - -' BUILDINGPERMIT ISSUED--------------'------------- -- ------------------- ------ DATE------------------------------------------------------------ Alterations and/or recommendations-----------------------' ----------------- - ----------------------------- --------- --- ----------------------- --------- ----------------------------------' ' ' '------------------ ------------- - ------------------ t ---------- ---------------------------------------------------------- --------------- -----' O.- INSPECTION. B ------- FINAL Date------/ �' '`-�' 6 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.mazolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 911h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.ea.