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V �r/h�II.,C U.�[ ------- --f ------— --' -, r a ------- .�- �� APPLICATION FOR SANITATION PERMIT Permit No. ---------------- -------------------------------------- - (Complete in Duplicate) 3 --- --- This Permit Expires 1 Year From Date Issued Date Issued --_-- --3 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. JOB ADDRESS AND LOCATION.---------IV-2- _ __-._• Owner's Name =t'- .r-s- ., C• ------------ Phone - e! [v Address--. o _�_/---------�L�l _T. .f�_.k..C�Q__-- Contractor's Name--------------------- _ -. -/ 'f-------_ cn'� ----- ------------------ Phone.JW501_0 -7 Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-1-- Number of bedrooms --16- Number of baths - -- Lot size ------ ,o2 -2 C Water Supply: Public system ❑ Community system ❑ Private R?"6epth to Water Table kO ft. Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam 5;/-Clay ❑ Adobe ❑ Hardpan ❑ ' Previous Application Made: (If yes,date.------ -----) No Q' New Construction: Yes ❑ No [3 FHA/VA: Yes ❑ No.� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------Material____.-.---_-___..---.-_ ------------------------- ❑ No. of compartments--------------------------Size---------- ---------------------Liquid depth--------------------------Capacity----_-- Disposal Field: Distance from nearest well_ oo.-Distance from foundation---- Distance to nearest lot line-,,2C- � Number of lines-----_------ Length of each line------—5.,5- ------.Width of trench--..---P� _ ."---- Type of filter material----_ .Depth of filter material---fgr��---------Total length---------I•. --------- ------ •- --- ---�. Seepage Pit: Distance to nearest well__/jPQ_.ATDistance fr m foundation__-,4V-tf'.I'Distance to nearest lot line_.,67F!. >91 Number of pits.---------f---------Lining material-?7/ -Size: Diamefer_ _,4P_._.. Cesspool: Distance from nearest well--------------_-Distance from foundation -----------.- Lining material--___-----___---------_-----.- ❑ Size: Diameter------------- ----------------------'-Depth--------------------- ------------------------.----Li Liquid Capacity-,-------------- - 9 --------------------------gals Privy: Distance from nearest well------------------------- .--.-----------.-Distance from nearest buildin to ❑ Distance to nearest lot line----------------- - ------ ----------------- ------------------------------------------ -------------------------------- ------------- Remodeling .� ---------- a 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, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)---------------------- -' - ,5-/ !'L` --------------------------- -----------------__.---__. ---- w and/or Contractor) BY- -------------- ---- --•--------- ---- --------- ------------------------------------------------------------------(Title) •-- ..--- -----. (Piot plan, showing size of lot, location f system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- . - -.---------------------------------- DATE-------------- ------------- REVIEWED BY -------- --------------------------------------------------- ---------------------------------- DATE------ - ----- UILDING PERMIT ISSUED------------------- - DATE----------- --------------- Alterations and/or recommendations:__ / -------------------------------------•------ -------------- ----------------- ------------------------ ---- ---------------------- --------------------------------------------- -----------•---•-------••------------------------------------•------------- ------------------------------ --------------------- ---------- --------------------------------------------------- FINAL INSPECTION BY:-'-- .. 1 `' Date------- f SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.F.CO.