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FOR OFFICE USE: / ---- ""----""" --- ----- - -------- ---------- APPLICATION FOR SANITATION PERMIT Permit No. _ _ _ (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 County Ordinance No, 549. M ------------------------------------------��-•- JOB ADDRESS AND LOCATION--------- 'sr`'1'e.` J �i1'`'`"`� --------_------.-.-._--. -_.... .. Owner's Name.------- .1w- —-----4i-r`. ------- -----------•--------------------------- - - Phone-.t:J`� Ad d ress 7�'L -* -y.... ----------------- ------- ---------- Contractor's Name --- �' ' ---------------- ------------ Phone.. �. ---- ------ Installation will serve: Residence ��A Apartment House ❑ Commercial ❑ Trailer Court ❑' Motel ❑ Other ❑ l*5' P ,,/ Number..of living units: .-.__." Number of bedrooms ...T Number of baths --il. Lot size __.laQ- .-- -. Q--- Water Supply: Public system ECommunity system ❑ Private ❑ Depth to Water Table ..----"- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan [I Previous Application Made: (If yes,date-------- ----------) No ❑ New Construction':; Yes ❑ No E] FHA/VA: Yes E] No [71, TYPE OF INSTALLATION AND SPECIFICATIONS: { (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f I Septic Tank: Distance from nearest well--- Distance from foundation F.. _-._ .��_....._-_.Material--___ d _ _ _ _"1f-I r116--1---- ----------- No. of compartments. Size ,�fJ`1aCc . ... - --Liquid depth-----------��,---------Capacity..---- Disposal Field: Distance from nearest well...e'�0"_Distance from found ion. � �IstancE to nearest lot -.--- ',��,// Length of each line A�Width of trench..... � ❑ Number of lines- ----IF--------- n- , � g -� �'�+ ----------------- Type of filter material....��./ Depth of filter material.....-f>r'�otal length...... .. e�_t?----------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot fine...........--..._ ❑ t p' g erial ----Size: Dia meter-.__ :__°`'.... ....Depth--------------------------------- C p I�um4,er of its Lining mai, dation----- ------------- Lining material-------- ------------------------ Cesspool: --------- ---- ', Cess ool: Distance from nearest well- ---- _----Distance from foundation Li,quid Ca aci ----------------------------gals. �• Size. Diameter-- - 04 ry Depth - q p tY ---- ` once from nearest well. .. ..-. ".. - --...Distance from nearest,Dist �-. . ' ❑ ----- ------ ----------------------------------------------- Distance to nearest lot line- -------------- -- --------- ----------------•--------- - Remodeling and/or repairing (describe): ; ------•--------"--------------------------•-------•-------------------------------- -------------------•---------------------------------------------------- ---------- ------------- --- - ---- ---------------------------------------------------------------------------------------------------------------------------------- -------------------- ------------------ ------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la S. and rules and regulations of the San Joaquin Local Health District, 4 -..(Owner and/or Contractor) (Signed)---------------------' ------- ---- --------------------- ----------- ---------------- (Title)------------ -- ------ - ---------- - (Plot plan, showing size of lot, location of s em relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY. -------------------------------- DATE "" ;!' - ------------------------------------------ REVIEWEDBY------------------------------- ------------------------------------ ----------------------------------------------------- DATE-- •--------------------•---------------------•----•-- BUILDING PERMIT ISSUED-------------- -------------------------------------------------------------- - --------------------- DATE--------------------------- --------------------------------- ------------------------------------------------------------------------ Alterations and/or recommendations------------------------------------ ------- ------ - --------------------------------•-----------•----------------::---- --------- ------------- -----------•-------------------- I -------------- ----------------- ...... ------- ~ Date- -------------"-4?.� 7...w?-�---- -----------------------"---- FINAL INSPECTION BY .... -- S JOAQUIN LOCAL HEALTH DISTRICT" 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street I Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.