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/FO OFFICE USE: T- -9 Z -----�- ----------------- ------------------------------ U---- APPLICATION FOR`SANITATION PERMIT Permit No. f��_ 1• ------------- - --------------- ----------------- (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 LO ATION -------/-��'--- �- ---------��-�__-------------�w-------- c = <f - Owner's Name- ----•-`---`-/u - Phone- - ------------------------------------ Address l� i . ` ------ ... - Contractor's Name-------------- -•-------------- Phone----•--- Installation will serve: Residence/ Apartment House E] Commercial [:1 Trailer Court ❑ Motel F1 Other E]Number of living units: -L Number of bedrooms __.3.- Number of baths __, - Lot size ------0-- ------------------------------------- Wafer _- `U______._._----------- Water Supply: Public system ❑ Community system ❑ Private e Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ 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.) / r Septic ank: Distance from nearest well - ...-f_Distance from undation__.--- - _-Dd No. of compartments �.Material_-----_C ZX4� - -- __ artments--_- _ _ Liquid depth__..--_ p =�----- -`-Size----� � J . ��j ------CapacitY-----�� - Disposal Field: Distance from nearest well....f-O.-f Distance from foundation----1.a_._t.--- istance to nearest lot line___._ / T r e� --•---- [ Number of lines--------------_ -__----.-.---_Lengi-� of each line--y0_t.�df--K0/-fC0idth of trench--- ..--_--_-----.---- Type of filter material— 1AGt�Depth of filter material----. 8_�t__--..Total length------, - Q r-_-----_--------_ Seepage Pit: Distance to nearest well- _-__.------_Distance from foundation------------------- Distance to nearest lot line---------------._ - ❑ Number of pits------------------ ---Lining material----- --------------- Size: Diameter----------------------.Depth--------------------------------- G Cesspool: Distance from nearest well--------------_-Distance from foundation------------------_ Lining material---------------------------- El Size: Diameter --------------Depth----------------- --------------------- ---- -------Liquid Capacity- ---------------- -----gals. Privy: Distance from nearest well---------------------------------------------- from nearest building Distance to nearest lot line--.--..---____-.-.-_ Remodeling and/or repairing fdescribe):----- ----------- p --•----------•-------------------- ------------------------------------------------------------•------------------------------------------------------------------------ ---------------------------------------------- --- ---------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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. . (Signed}----- � t�.- (Owner and/o�-Cee#Fa�#cr.� By:. ---------------------•--------------------------------------------------------------------------------------(rifle)------------- ----------------- ------- --- ---------- ------ (Plot 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-.-- .._YL_---C-.!" ! ------ --------------------------------------- REVIEWED BY - DATE. � ``1 --------------------- ---------------- ------- -------------------------------------------------------------------------------- DATE ----------------------------------- I DING PERMIT ISSUED------------------------------------------------------------- - -=---------------- DATE - ------------------- - - ------------------------ Aiterations and/or recommendations------------------ -------- -------- ---------------------------------------------------------------------------•-----------------------------------------••------------ ------------------ ------------------------------------------1------------- FINAL INSPECTION BY:--..� ; i ---- - Date------ -l-o--`-- ---------•------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 724 Sycamore Street 205 west 91h Street Stockton,California Lodi,California - Manteca,California Tracy,California F.P.Ca.