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FOR OFFICE USE: _ a� _.- _.--._.-€___________________ APPLICATION FOR SANITATION PERMIT Permit No. _c ............ (Complete in Duplicate) � i" -_.___.:.__- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby madeito 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 LOCATION4'Y <- r ------------------------Lt -- -- -=----- --- - Owner's Name--- t ,;------- �iW�.{r '--------- ` ----------- Phone------------------------------------ Address----------! -- Contractor's Name----f7� -------------------•---•---------------------------------------------------- -------------------------------- --------- Phone------..------•---•--------•----- Installation will serve: Residence .�] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel C] Other ❑ 25 Number of living units:/--.--- Number of bedrooms A---- Number of baths 1------ Lot size --3.. ------------------.------.------___-____--- .-- Water Supply: Public system ❑ Community system ❑ Private-D Depth to Water Table .Q__ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam,[E 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 tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weli-----------------Distance from foundation___________________Material--_.__._--___---__----__.______----...---------- ❑ No. of compartments--------------------------Size-----•-------------------------Liquid depth-----=--------------------Capacity------------- --------- Disposal Field: Distance,from nearest well_n-..--------Distance from foundation---�b----------.Distance to nearest lot line-4—�___-.--- 93 Number of lines----l______________---------------Length of each line.__ 4_4i-------------- of trench-__.1 ' material Type of filter material-4--t of filter material___f - ______Total length---_>.7q ---------------------------- Seepage ---------------_______-. Seepage Pit: Distance to nearest well_------------_--------Distance from foundation--------------------Distance to nearest lot line----------------- 0 Number of pits-- ---�-_----------Lining material-----------------------Size: Diameter----------------_------Depth-------------------------------- Cesspool: Distance from n ares+ well-----------------Distance from foundation_. .............Lining material------------------------------------- Size: Diameter.."_:i"-- p t ------Liquid Capacity----------------------------gals. Privy: Distance,,romi nearest well____---------------------------+ ._..Distancexfrom nearest building--------------------------."�._ ❑ Distance"fo nearest lot line__________________ ; iy ___________________________________________4_""" ------------------ ---------------------------------------------------------------- Remodeling and/or repairing (describe): -__'.:__.-.--, --.- ------------------------------------ ----------- ; ---------------------------------------------------------------------------------- --- ------ ----------------------- -------------------- I -------------------------------------------------------.----------------------------------------- -__-___------_----------_q---------------------------------------------------------------------------------.______----_---- - I hereby certify that I have prepare this application and that the work will be done in accordance with San Joaquin County ordinances,ZSfdfe laws, and rules and regulatfiion's of the Sen Joaquin Local Health District. (Sig ) f y - r Q (Owner and/or Contractor) B/ s ------------ (Title) ....... ..... ............. ---- (Plot plan, showing size off lot, location of system in relation to wells, buildings, etc.. can be placed everse side). NIL FOR DEPARTMENT,USE ONLY APPLICATION ACCEPTED BY.. -/&�. tea.•4 _______________________ - r`/ "�7 DATE -' -- - -- ----------------------------------------- REVIEWED -- -- ----- --- - ---------------REVIEWED BY-------------------------------------------------------------------- =------------------------------------------------- DATE - 9 BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------- ------ -- DATE------------------------------------ - ---------------------- '. Alterationsand/or recommendations----------------------------------- -- -------- ------------•------------------------------------------•----------------------------------------------------- --- --------- ------- --------------------------------"-----------------------------------:-------•------------------------------------------------------ FINAL INSPECTION Dat _ 7 e -� - SAN JOAQUIN LOCAL HEALTH DISTRICT 7601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca, California Tracy, California F.P.C W.