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FOR OFFICE USE: - - APPLICATION FOR SANITATION PERMIT Permit No. ._�....�,a....__... ------ • -- -------- �,--—-------------- (Complete 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 Count r •nance No. 549. JJ JOB ADDRESS AND LOCATION_______ -1_. _- _--- - -- --- --------- _ .• .�----r �j �j Owner's Name-------- ---- - -------- Phone44Q�s �erlfi - ----- - -- ------ - �j - Address-_....- _ - f ; ---- --------- ------------- -------•---- --- p '�/ Contractor's Name---- ` ------ -- --- ------ 3 -�----_3--tT_-+--------------------- PhoneS lr Installation will serve: Residencepartmen House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t Number of living units- -1----- Number of bedrooms __Number of baths I---- Lot size ___'3__99.___�7�____1_c---------------- Water Supply: Public system >(I Community system ❑ Private ❑ Depth to Water Table- ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ 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.) S Distance 'frorn nearest well_________________Distance from foundation-------------------.Material_____..._____._.__._...._______._.____._______-- No. of compartments- Size---------------------------------Liquid depth-------------- -------Capacity--------:-------- /� r D' I Distance from nearest well_ __ Distance from foundati n--- __Q..___.Distance to nearest lot�line--- ____C✓_.._ Number of lines____��___ _ _ __Length of each line_. "��_�_ _�_____._.Width of trench___�_Y0r______________ r� Type of filter materiah ` jl�_.Depfih of filter material-__-/-q --______Total length___._._._- �9_ _______________ \ Seepage Pit: Distance to nearest well------------------.---Distance from foundation--------_-----------Distance to nearest lot line-.___.-.-__._-.-_ ❑ Number of pits------------ "----_-Lining material-----------------------Size: Diameter-----------------------Depth---------.----------------------- Cesspool: Distance from nearest well_ _____________Distance from foundation-------------------.Lining material-----------.__..___.__.___________.__. l,U ❑ Size: Diameter "------------------- Depth------------,-----------.--------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest weli-------------------------------------------------Distance from nearest building-------_------------.----------...------- Distance '� ❑ to nearest'lot 1ine----------------------------------------------------------------------------------------------------------------------------------------- Remodeling and or repairing (described=------------- ----- -- - - --- ---- --- _ _ ___-- ___-- ------.------------------------• -- -------------- } -- ---------------------------------------------------------------------------•------------------------ --- ------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I -------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances to s, and es and ulations of the San Joaquin Local Health District. . . n- I (Signe - ` -d� !- �5 -- Contractorl By:----------------------------------------------------------------------------------- --- . --- ---(Title)--:------------------------ - -------- -- --- ------------- (Plot plan, showing size of lot, location of system in relati to wells, buildings tc., can be placed on reverse side). F DEPARTMENT USE ONLY I� APPLICATION ACCEPTED BY----------- ------ ------------------------------------------- DATE----- _:-"` --��------------------------. REVIEWEDBY------------------------------------ --- --- --- -- - --------•._------ ------------------------------ DATE------ ---------------------------------------------------- BUILDING PERMIT ISSUED -- - - - ------ DATE------ ----------------------------------------------------- Alterations and/or recommendations:---------------------- ----------------------- ------------------------------------------------------------------------------------ -------------------------- ----------------------------------------------------------------- -------------------------------------------------------------------------- ----------------------------- --------------- ----------------------- --------------------------------------- -------------------------------- ---------------------------- --------------------------------------------- ---------- ---------------------------------------------------------------------------------------------------------------------------- -------------- ------------ ---------------------7--------------- --- --- - --------------------------------•---------------------- ---- ----------------------------------------------------------------------- -------- FINAL INSPECTION BY: ------- --------- - Date.--------�� - - - ---- - - -- ------ ---------- ---------- AN �AQUIN LOCAL. HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California