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FOR OFFICE USE: ----------------� APPLICATION FOR SANITATION PERMIT Permit �No. __�a_1�& (Complete in Duplicate) - This Permit Expires 1 Year From Date Issued bate Issued' _ Applrcation 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 A D LOCATION 1" 24 ' rz--rte( Owner's Name -----? -----------------------------------•-------------------------------- ------------------------ -------------- Phone----- ------------------------------ Address------------ ,�,-x.�/ Contractor's Name-----------yam=--- ... Phone--------------------__----------- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-_L__ Number of bedrooms ___ _ Number of baths __Z_ Lot size __-_ _g 2C• __ _`�`t__________________________ Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table 4._dit._ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ej—Hardpan ❑ Previous Application Made: (It yes,date__._>___---- ________) No Q New Construction: Yes ❑ No FHA/VA: Yes ❑ No ['-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No se tic tank or cesspool permitted if public sewer is available within 240 feet.) t�w Septi Tarik Distance from nearest welt------------------Distance from foundation-------------------,Material----___--_---------------------------------------- No -----____________________--________-- No. of compartments------ -------------------Size-----•-----------------•-------Liquid depth-------------- Capacity Disposal Fi Distance from nearest well_---"`---------Distance from foundation-/p-_f--__-„-Distance to nearest lot line__6___j_____- Number of lines--- ------------------ ------Length of each line----Ga-''----------------Width of trench_-.-Z'-5r--`�-------------------- Type of filter material:_l qc_AC_____Depth of filter material_/?----------------Total length--------6.6__'-___________________ Seepage Pit: Distance to nearest well_____ ____Distance from foundation__/C`_-----------.Distance to nearest lot Number of pits-----_--------------Lining materia ____Size: Diameter-___3 C-----_--Depth_ ----------------- ------- 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------------------------------------------ 01 ❑ Distance to nearest lot line_________________________________ Remodeling and/or repairing (describe)---------- ----- -------------- -----•-------------•-----------• --------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------- ---------- ----------------------------•-----------------------•---------------------------••-------------- ----------------------------------------- ------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that ave prepared this application end that the work will be done in accordance with San Joaquin County ordinances, State laWY116 ru V •and re ions f the S n Joaquin Local Health District. (Signed)------------------ -- - ------ ------------------- ---- ------ ---- -rl------------------------------------------------------------------(Owner and/or Contractor) By----------------------------------------------------------- -------------------------- -------------------------- ------------------(Title)---------------------------- -- ------------ ------------ - --- (Piot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -------------------------------------------------------------- ATE...... _ '.._._ REVIEWEDBY--------------------------------------------- ----- --------------------------------------- ---------------------------- ----- DATE------------- ---------------------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------------r--------- DATE----------------------------- ------------------- A terations and/or recommendations------------------- -----------------------------------... ------------------------------------------------------------ ---------------------------------------------••----------------- ----------------•--------------------------------------------------------------- ------------ --------------------------- ------ ------------- ----------------------------------------------------------•------------------------------------------------------------------------•--- ----------- ---------------------------- •-----------------------------------_---------------- ------------------------------------------ ----------------------------- ----------------------------•--------- ---------- ------------ -------------- -........ -------------------- . --------------------------------- -•-------------------------- -- ------------ -------------------------------• � l - (�f f FINAL INSPECTION BY:-- - 14I�A _ - ------ Date--------_ - -- U - - -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi, California Manteca,California Tracy,California c.a.co. 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