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FOR OFFICE USE: t APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------- - ------- ------ (Complete in Duplicate) 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 construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. .... -- -------------------------- ---- ----•-------------------------------- J08 ADDRESS LOCATION_ _____ -,..._lrfl __ ___ __________________ __ -_ _ __ _ Owner's Name----- _11,h -- --- ------ Phone------------------------------------ Address --------•-•------- - -•._-----••----------------•------------ - ---- --------------------------- -----------.... Address-------=--• - --•XqQ!- ;o.... `_ ® ��------- ------ ---- Contractor's Name--------....04 1- _ _111_W1 W --------- - ------ ---- --=----- -••--- ----------- -- Phone----_-----------------••-- -.--- Installation will serve: Residence B0"Apartment House ❑ Commercial ❑ Trailer Courtl❑ Motel ❑ Other ❑ i Number of living units: ---/.- Number of bedrooms ,-Z-_ Number of baths �'-_ Lot size ---------------------------- Water Supply: Public system Z?--Community system ❑ Private ❑ Depth to Water Table 4401 ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [ New Construction: Yes ❑ No 'FHA/VA: Yes ❑ No t TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitfed if public sewer is available within 200 feet.) 1 Septic Tpjnk: A- Distance from nearest well-----------------Distance from foundation-------------------Material...____..___...----------------------- .--------. No. of compartments----- ------------- ------Size---------------•----------------Liquid depth--------- ......... ------Capacity------------•- Disposal Field: Distance from nearest well. ................... Distance from foundation.Z.:5 --------Distance to nearest lot line__ _-----__ T e of filter materia�.�__. ___Depth of filter material f .- Width n +r--- _• _-`________________________ �upmber of lines.-------- �_... Le P th of each line__- �--�---- ------Total length-._�. ---------------------------- Seepage �_ - ------------------ a Seepage Pit: Distance to nearest well-----.-----_`__---_Distance from foundation-------------------Distance to nearest lot line----_.-_------.- ph ❑ Number of pifs----------------------Lining material-----------------------Size: Diameter_------.--------------Dept h.-----------------------------.- V, Cesspool: Distance from nearest well ------_.4.-----Distance from foundation--------------------Lining ❑ material---.---.------------.-------_---- Size: Diameter---r t De th - Luid Cpacity--- -----ga_€s_.. Privy: Distance from nearest well--------------------------------------------------Distance from nearest building--------------------------_....-----.----- ❑ i Distance to nearest-lo+.lire--------- ---------- -----------------------------------------------------------------------------------•----------•------•-------------- Remodeling and/or repairing (describe):------------1 _ _--M1 --------------------------- .------------------- \ 1 ----------•---•----••----------•----•--------- ---------------•----------------------------------------------------------=---------------------------------- ------------------------------------ ------------------------ --------------------- ------------------------- ----------------- ------------------------------------•---------•--•-----'-------- ----------`--- ----------------------- -- -------- I hereby certify that I have prepared this application and that the work will 6e'done in accordance with San Joaquin County i ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. III (Signed) �-._ � -_--_`. for Contractor} BY --- }Title)__. Ii flt - -------- f.�`�'� (Plot plan, showing size of lot, location of system in rel n to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- - ----- ----- - ------------------ ------------------ ---------------------- ------------- DATE------ ?/ _ --6-,;;-------------- ---------------- l REVIEWED BY---=----- ------ -------------------- ---- ll •------------------------ ---- -------------------------- DATE-------- ---•------•------------•----------------------- BUILDING PERMIT ISSUED---------------I------------ ------------------------------------------------------------------------- DATE-------------------------------------------- ---•---------- Alterations and/or recommendations i ---•--------------------------------------- ----•-- ------- •-•----•-------- I / FINAL INSPECTION BY:_Q�_.�.��C..--�-------------------- ----------------- � Date.- - -----------� ------ -- � ------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 724 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.