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FOR OFFICE USE: ------------ - ------- ----------------------------------------- ------ APPLICATION FOR SANITATION PERMIT Permit No. _142_----------------_ ---- ----I--- ------------------------------------- (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_ described. This application is made in compliance with County Ordinance No, 549. JOB ADDRESS AND LOCATION_- --- ----- Owner's Na e------ - --- - ---------------------- - ------------------ Phone------ ----•---------•--•--........ Address.---- ---------------- ----- Contractor's ---Contractor's Nam --- ----- --- ----------------------------------------------- --------------------------------------------------------- Phone----_-------------_-------------•- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel 0 Other ❑ Number of living units: ---I--- Number of bedrooms __a2—Number of baths _1__-_ Lot size - ------------------------------_ / t Water Supply:, Publicxsysfern ❑ Community system E] [L' Private• Depth to Water Table L�-aft. ` Character of soil to a depth of 3,feef: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E��Iardpan ❑ Previous Application Made: Ilf yes,date--------------------) 'No [T-"'�New Construction: Yes [J'No ❑ FHA/VA: Yes ❑ No ®— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) L � n Septic nk: Distance from nearest well_�e_ _Distance from foundafion_-L_.0--- ---------Material....._-. ---_.______-._-_. No, of compartments-----2_____________r"-Size___.s3__��K_9____Liquid depth_-------- ;--------------"Capacity.--- 'OG� Disposa{ Field: Distance from nearest well-16 _-Distance from foundation_Y ----------- Distance to nearest lot line__(S - r -- .. Number.of lines______ _______"-"._______-"_ " Length of each line___�_!�"_"_._____--____._-Width of french ................. Type of filter material-____ Depth of filter material-��-----------------Total length------F-a_._ ____.__"-_- iSeepage Pit: Distance to nearest well/kn_O------------Distance om fou dation_" 0---------- Distance to nearest lot line.... r_-_.. Number of pits----I--------------Lining material_-__ ____ G -Size: Diameter__-._�_3._7 i__"".Depth_..._-.�.� _-_-"""".-_ Cesspool: Distance fromnearest well-----------------Distance from foundation--------------------Lining material-----------------_-_--_-_______-_-_-_. ❑ Size: Diameter------------------------------------ - -----------Depth--------------------------------- ----------------Liquid Capacity----------------------------9als. ' Privy: Distance from Inearest well-------------------------------------------------Distance from nearest building-----__-____---___-______-____-__-----_- ❑ Distance to nearest lot line-�------- =------------------------------------------------------------------------- Remodelingand/or repairing (dest ribe):---------------------------------- ----------------------------------------------------------•----------------------------------------------------------- } 1 ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------ --------------- I hereby certify th?_r had this appli afion nd that the work will be done in accordance with San Joaquin County ordinances, State laws, gulations the an Joa in Local Health District. (Signed) ---------------- ------- ----------- ----------------------------------------------------------------------(Owner and/or Contractor) By: --1------------------------------------------ ----------------------------------------------(Title)-------------------------------------- ------- ------- ------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, efc., can be placed on reverse side). t R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----: --- - --- --- ------- ---------------------------------------------- DATE------� r1�-r------------------------------- - REVIEWEDBY--------------------------- = -------•---------------------- ---------------------------------------- DATE----- BUILDING PERMIT ISSUED--------- -- ------------------------------ ---------------------------------- DATE Alterations and/or recommendations:------------_---------- -------- -----------------------------------------------------•-•- --------------- --- -�---------=------------- / - - --------------------------------- ------------------------------------------ - - - -- -- - ti.. -------------------- ----- ----------------- l. r 1 FINAL INSPECTION BY: --- - --- -------------- --------- !]ate �f --�---fib _ F N JOAQUIN LOCAL HEALTH DISTRICT 1601 f.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California