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FOR OFFICE USE: r -------- -- ------------------ ----- --- ---- --------- APPL ?ATION FOR SANITATION PERMIT Permit No. _ _.1.... .: ------- --- ------------------ ----------- -------- (Complete in Duplicate) ___ ___ _ ______________ This Permit Expires 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 descried. This a_plicat mIs-made,in o mpliance with Cunty Ordinance No. 549. j JOB ADDRESS AND/LOCATIOIN- �. `4 ---AW----- �+Owner's Name_____..__-- ---- - - - - -------'--------------- ------- Phone------------------------------- Address --... ------- - - - ., �i - ----------------------------------------------------- Address..........e _+..- �- .. .. ° _ = Contractor's Name ---------------------------------- ----- -------------------- ----• •---- Phone---•-------------------_-•-- ;� Installation will serve: Residence ❑ Apartment House.❑ Commercial [] Trailer Court ❑ Motel ❑ Other' Number of liv' ,g,!%nits:/______ Number of bedroom___ Number of baths I----- Lot size ---------------!I �°' 1A 4 Water Supply: Public system ❑ Community system ❑ Private'A] -Depth,,to Water Table/J�-- ft. Character of soil toga depth of 3 feet: Sand ❑ Gravel ❑ Sandy LoamAM Clay Loam ❑ Clay ❑ !Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic_tanlc or cesspool permitted if public sewer is available within 200 feet.) '- ? Septic Tank: Distance from nearest well4i$47tO-------Distance from foundation_10-------------Material_ IN No. of compartments------;C----------- ----S;ze__Ir?_•�_X-----------Liuid de th____._ _Ca acit Y- jV------F--- � Disposal Field: Distance from nearest wells R-.__.__Distance from foundation.,1_0..._........Distance to nearest lot {�] Number of lines________ ,,,��-------______Length of each lin e1""'__.�_+12_______-Width of trench__ '�_______________ � Type of filter material s!_.-------_-__Depth of filter material---��_"-----_Total length___./� �___ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line-------------- El Number of pits.-_----------e-------Lining'`material-----------------------Size: Diameter-------------------.---Deptn_..--.------------------:-------- , Cesspool: Distance from nearest eff________________Distance from foundation--------------------Lining material_ -------------------------------____ Size: Diameter------------ -------_Depth---------------------- ------------------- .Li Liquid Capacity gals.El !I . C I Priv Distance from nearest well--------------------------------------------------Disfance 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 ordinances, St laws, and ruless a ,emulations of the San Joaquin Local Health District. (Signed) All --------------------------------------- --------------------------------(Owner and/or Contractor) _ ---------------------------------------= — b. Y=-------------- _ iTitle) == W ..'.`...._.,, +s (Plot plan, showing size lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY _. -- DATE_- -------------------------- REVIEWED `_!__--GREVIEWED BY------------------------------------- -- - -- -------------------------------------------------------------------------------- DATE-------------------------------------------------------'i- a BUILDING PERMIT ISSUED-------------------------------------- --- ---------------------------------------------------------- DATE--------------------------- -----------------,-----------, + Alterations and/or recommendations:------------------------------------------------------------------------------------------------------------------------- ---------I .. 11 ------------------------------------------------------ ----------------------------------------------------- ,I --- ----------- I FINAL INSPECTION BY:.,, ------ Date_-----_�.` ---------------I- ' -- ------------ SAN JOAQUIN LOCAL. HEALTH DISTRICT -I j 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.