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FOR OFFICE USE: --------------------------------------------------------- _______ APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) -- -------------------------------- // This Permit Expires 1 Year From Date Issued Date Issued .SP-_ __-__, 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. JnI 0 S f 30 rt q JOB VDRESS A��N��D// LOCATION_3a0_o_Z_._u�_._-_f f F- -u~�--- � Ro------------------ - ----------- Owner's Name - [.(/.�� 1__...._ - - - ------------------------------------------------------------------- ----- -------- Phone--34-IF-7:5,2-111f. Address------------ -- ----------------------------------------- Contractor's Name rlr✓- — -�►+ ---------------- ---------.-- Phone--------------__.......----------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __�__-_ Number of bedrooms .___ Number of baths _?Lot size ____________________________________________________________ Water Supply: Public system ❑ Community system ❑ Private 0 Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand [j Gravel [:] Sandy Loam ❑ Clay Loam ❑ Clay dobe ❑ Hardpan ❑ F ' 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 well_________________Distance from foundation--------------------Material-------------- ----_-------_-________.____-____. w ❑ No. of compartments---- -- -- - - ----------Size-------------------------- Liquid depth--------------------------Capacity--•-------------------- Dispos Field: Distance from nearest well-A-9) A----.--Distance from foundation___. _.:____.Distance to nearest lot line___'`~____.__... [N Number of lines-------------J_--------------------Length of each line--------.SA_--------------Width of trench_._._Dl""- -------------------.- Type of filter material______---!—- _____Depth of filter material___.. ---------Total length_ ---------------------------------- Il{ Seep a Pit: Distance to nearest well------�0�__i_____Distance from foundation----Ja_._.___.Distance to nearest lot ii _.,f__.�_____._ Number of pits---------/.-----------Lining material___.__ _ ___-_-Size: Diameter.___*F_._...__-Depth---Ax-_____________.___.__ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----_______________.______.________- ❑ Size: Diameter--------------------------------------Depth--------------------------------- -------- - ------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____-________.____.________..__._.__.-. i ❑ Distance to nearest fot line--------- ------------------------------------------------------------------------------------------------------------------- ° Remodeling and/or repairing (describe):_____...-. _._-_______ _-_____•_______________•_-_____•.--------_------_---------_-__ - -_ - __--__---_ _-______-__________-__-_.__________________------.---------------------------------------.----•._.--------------------------____.-_.__ w/l - _________________________________________________________________________________________________________________________________________________________________________________________________________________------- ------------------------------------ --- _______________________________________________________________________________________________________________________________________________________________________________________________________________________________ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, a e laws,-and rules and regulations of the San Joaquin Local Health District. (Si ned -------------------- ------------ 9 �----- ----------------------------- - - - - - ---- --- - -- and/or Contractor) __Title (Plot plan, showing size of lot, location of syste in relation to wells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED I3Y ------------------------------------------------ DATE_ 6_2-------------- REVIEWEDBY--------------------------------------------------------- ------ ------------- --------------•----------------------- DATE BUILDING PERMIT ISSUED------------------------------------------------------------------------------------------- --------- DA•TE--------------- -------------- Alterations and/or recommendations-------------------------------------- -- ----- ---------------------------------------------------------------------------------------------------------------- ------------------------ -------------------------------- - ----------- -------------------------------------------------------------------------------------------------------------------- ---------------------------- -------------------------------------------------------------------------•------------------------------------------------------------------------------ ---- FINAL INSPECTION BY ............. . ' ? r' . ------------ Date-ley ------�---- �C .. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California