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FOR OFFICE USE; 7 -------------------------------- ----------------------------- --- ------------ .APPLICATION'FOR SANITATION PERMIT Permit No. -- ---------------- ----------------- --- --------- (Complete-in Duplicate) ------- -_ - This Permit Ex fres 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 described. This application is,made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION.A-)--_ eC_y 13 ----------_' . s � �� . _ .. .... --- --- - ------------- Owner's Na e---- F,JT' Phone Address-__ Contractor's Name----- ---- •----------- ------ ------------- ----------------------------------- --- ----- _-- - - Phone--------•-------------------------- 4 Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel [I Other ❑ Number of living units: ---f-- Number of bedrooms _1_._ Number of baths J---- Lot size __�"__.�. �p_ ____________________________________ Water Supply: Public system E] Community system [] Private Depth to Water.Table gp ft. Character of soil to a depth of 3 feet: r Sand [�C�ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,.date--------------------) No E4,�-�ew Construction: Yes Rj"Ro ❑ 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 wells4� '-_f_____Distance from foundation_Za____-__-__...Material- ------------------ ®� m f No. of copartments_�-------------------Size:_457��_L_K_6 �-f___'_Li Liquid de th___'`f_r---------q p ------------CapacitY--- Disposal Field: Distance from nearest well__.rP-�_---Distance from foundation.-/P__ --------Distance to nearest lot line-- Number ine_Number of lines----19---------------------------Length of each line_&k__---- _4_-_/QF.Width of trench__.__ __`-..----.---- -- .Type of filter maferial__'__]ToCt---------Depth of filter material---/$` ------------Total length----A-1.0-------------------------- Seepage Pit: Distance to nearest well-----_----------------Distance from foundation--------------------Distance to nearest lot line..__----__.____._ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter---.-------•---------.-Depth------------------------- r 1� Cesspool: distance from nearest wefi-----------------Distance from foundation...................Lining material-------------------------------------- El ___---_______- .( ❑ Size: Diameter---- ---------------------------------Deth--------------------------------- ----------- ------Liquid Capacity----------------------- Privy: Distance from nearest welf_______---------------------------------------..-Distance from nearest building.--._...___________----______-----_-_._. ❑ Distance to nearest lot line--------•------------------------------------------------------- ------------ r - � Remodeling and/or repairing (describe}------------------- -------------- ------------------_------�--- --•-•------------ - - --•----------•--------•--------------------------------------------------------- ---------------------------- -------------------------l----------------------------------------------•----------------,--•------------------------- _. 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. Si ned �•� �_»- '' ( 9 ) - -- ------------------------------------------------------------------------------------•---------------- --(Owner and/or Contractor) -- '1 BY:------------------------------•----•---- _ = - (Title) (Piot 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 BY - ' -------------- -- ------------------------------------------- DATE--- ` fvS REVEEWEDBY__-._-r" .'- = =-----------"------=--- --`- - ------- ----------------------------------------------------------- DATE---- - ---- BUILDINGPERMIT ISSUED------------------------------------------------------ --------------- ------ -------------------=---- DATE--------- ---------- ------------------- ---------- ------ Alterations and/or recommendations:............................ f ------------------- ------••- ----------------- -------=----------------- -------- -------------------------_----- ---------------------- •--••------------------ -----------------•-------------------------------------- ----•--•- ----------------------------- -------------------- •---•--------•••-----------•------•-•-------------------------------------- ---•--------------------------- ---------------- - ------------ ------------------------- ---------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:_...�.-.`. L -_-y _ Date---- ----------------------��L ' c 5 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, i 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California {I Lodi,California Manteca,California Tracy,California F.P.O O.