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FOR OFFICE USE: YNo. APPLICATION FOR SANITATION PERMIT `3 Permit . ..... ........ -------- ------------------------------------------ (Completa in Duplicate) Date Issued --------------------------------------------------------- This Permit Expires 1 Year From 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 �' ------- Owner's Name ^ - --------._. Phone.-- ----- Address---------- rvoll-, ---- s---•------`------------------•-------------------------------------------------------•-•---------••-----------------------------•--------. Contractor's Name--------------- ��' ��lr Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___ Number of bedroom____ Number of baths ____ Lot size '2149 --- --___-_____________ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table k+ ft. � 4 Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: jif yes,date----------------.....] No Ze New Construction: Yes ❑ No ® FHA/VA: Yes ❑ No 21�_ TYPE OF INSTALLATIOIN AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f` Septic Tank: Distance from nearest well_________________Distance from foundation-------------------Material____-____,___.__________________..___---------- rrt�stl Y No. of compartments - - -- `--------Size---------------- ---------Liquid depth-------------�-'�---- Capacity-------------:---------- f Disposals Field: Distance from nearest well__�V_..._Distance from foundation_A� ____.Distance to nearest lot Number of lines.__._---_ .-- .._ -en th of each line__ "Width of __ --------------- y6g ::.. 1Type of filter material__,e / epth of filter material---- .._.___Total length__ __ _________________ Seepage Pit: Distance to nearest well----------:------.---Distan(fe from foundation---------------_____Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material----------.------------Size: Diameter-------`...._....___-.Depth-----------------------------.--- V Cesspool: Distance from nearest well-----------------Distance from foundation---------------"_.Lining material..............._----_______.__-______ ❑ Size: Diameter------------------------------------Depth----------------------------------------------------Liquid Capacity----------- ----gals. r Privy: Distance from nearest well--------________________'_-':_:-- __ .......Distance from nearest building_ _-------__.__________________.._____- ❑ ----------------------- Distance to nearest lot line-4 ".,»------------=---- ------------- �- --=---------------------=--------------------------------- - Remodeling and/or repairing (describe)------------ � � -------------------------------------------------•-------- ------------------------------------ -------------------=----------------------------------------------------------------------------------------------------•----- ------I- -----------------------------•------------------- -------------------------------------------------------------------:---------------------------------------------------------------------------------------------------------------------------------------------- ----- ' 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. f (Signed)--------------------- J y e — ------------- - --- -- ----- -- /. r Contractor) BY:------------------- ---7--------------------- ' -- } (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY AP?LIGATION ACCEPTED BY------- o -------"` ------ --------- DATE rI': ~ REVIEWED BY-------------------------------- --------------------------------------- ---------------------------------------------------- DATE------------------------ ----------- ------ -- BUILDINGPERMIT ISSUED------------- --------------------------------------------------------------------- ----------------- DATE----- -----------•------------------------------------------ ;Alterations and/or recommendations:-------------- ------ ---------------------------------------------------------------------------------------•--------------------------- ------------------ -------------------------I-------- ------------------•-----------------------•-------- ----------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------- - -------------------------------- -----------------------------------------------..."--------- ----------------------------------------------------- --------------------------------------- ----- - -- ---------- -------- ---------------------------------------------------------------------------- ----------------- ---------------------------------------------------- -------------------------------------------------- ----------------------- - --- ------------------------------------- ----------- -------------------------- ------ ...-------------------------••-- FINAL INSPECTION BY:._._.. -- -- ---------------------- Date----- ------ ------------------------- U SAN JOAQUIN LOCAL HEALTH DISTRICT k 1601 E.Hazellon Ave. 300 West Oak Street r 124 Sycamore Street 205 West 9th Street Stockton,California Lodir California Manteca,California Tracy,California