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FOR OFFICE USE: ----------------,......:__ _ ---- --,-- APPLICATION FOR SANITATION PERMIT Permit No. pp��' - -- -------- ------ (Complete in Duplicate) Date Issued -`4 -------------------------------------------------------. 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 applicationis•made,in compliance with County Ordinance No. 549- �7 - ZfQ•-C , 8 C r JOB ADDRESS'AND LOCATION-1 ------------------------------ ^1E _ _ ZE1E 'L— T Owner's Name-------------- fad---------- F�_I-t_GjF_W:TE --------------- Phone-------------------------- Address------------------ ): .. a ---------I��----------- Contractor's Name-------p AOtl W�..--•---••----i----------------------------------------------------------------•-------- ----------------- Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ 4 Number of living units: ___f--__ Number of bedrooms Number of baths __�___ Lot size ___._�i�_ff�----Fi-Z�----------------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table _Oft. . Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan E] Previous Application Made: (If yes,date------------- --) No 93"�New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE ;OF.INSTALLATION AND SPECIFICATIONS: -(N,o-septit4iank or cesspool permitted if public sewer is available within 200 feet.) Septic'Ta-nk` .-Distance from nearest-well-_--- _-Distance-from•-foundation_____--------------- Ma#erial____ t_:1d�TI rQC p ---------------Liquid depth - ------ - - ------------Capacity-----------5� ,. n r- No. of compartments . Disposal Field: Distance from nearest well___ _____Distance from foundation_:___t_Q---------Distance to nearest lot line___ri___.__--___. \' jEX�Tf^f6- Number of lines---------/------------------------Length of each hne---------- D� �J---�1�-- - Width of tTench-----------7'�--�'-'----------------- `f- A t)Y> Type ofF�filter rriaterialGC Depth of filter material___-_ -------Total length______________� ----------- Seepage -_-___--__See a e Pit: Distance:`toanearest well-___------------------Distance from foundation--------------------Distance to nearest lot line----------------- El ____-________. _❑ Number of pits--------------- -----Lining material------------,----------Size: Diameter-----------------------Depth------------------------- Cesspool: Distance from nearest.well-----------------Distance from foundation-----:--------------Lining material------_-_--------------______________- [❑ Size: Diameter--------------------------- ----- ----Depth--------- - ----- ------------------ -----,---------Liquid Capacity--- ------------------------gals. " Privy: Distance from nearest'wel---------------------------------------------- from nearest building------------------------------------------ Distance _ _______-___________-_____---Distance to nearest lot line------ ---------------------- Remodeling and/or repairing (describe):---------Ai--1.7_-'- _ __._... .h _ - -.......:r_�!------(r -- ---Z ----- -------------- -- - - -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance State laws, and rules and regulations of the San Joaquin Local Health District. 5i ned .t __________________________________________ ___________Owner and o'r Contractor By -------------------------------------------------------------- ----- --------------------------------------(Title)------------------------------------------- (Plo+ plan,showirig size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse-side): -"- - FOR DEPARTMENT USE ONLY APPLICATION ACCT BY---- �... R-QCs'- DATE----------- --- �-------- REVIEWED BY--- '------ ------ ---- --- ------ DATE---------------------------------- - BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------- ------------- --------------- Alterations and/or recommendations------- ----------- --- ------- --- ------ - ----------------------------------------------- ----------------------1-------------------------------------- } ----------------------I--------------- --------------- ------------------------- --------------- -------------------------------------------------------- ------------- - -------------------------- -- • ----------- ------------------ ----------- ------- ------ - ------------- ----------------------------------------- --------------------------------- -- ------------ ------------- - ------------ -----------; -------- -- - -- ----- ----- ------ FINAL INSPECT-1�N �--- -------- -- ---- --- Date_...... l/_._.- __ _. i i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street a Stockton,California Lodi,California Manteca,California Tracy,California F.F.r_O.