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FOR OFFICE USE: --------------- -------------------------------------- - ll APPLICATION FOR SANITATION PERMIT Permit No. ------------- -- --------------------------------- Clete in Duplicate} _ N . This Permit Expires 1 Year From Date Issued -�---- (Complete 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. �,11i.J OY h3—�7 -- � JOB ADDRESS AND O ATION____ --- - l� . -- Phone Owner's Name---------- '"' "�L ��" - ------------------ Address--------------------- 1 ..... - -.._ ------------------ -��-------`------------------------------------------------------------------••---- r j n Contractor's Name .I - -- ------ ------ - --------- Phone r Installation will server Residence Apartment House ❑. Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: __ -- __ Number of bedrooms __s Number. f baths - Lot size _400-4--e—--- ---.---- 1 ' Water Supply: Public.system ❑ Community system ❑ Private Depth t Water Table 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..) Septic Tank: Distance�:from nearest well-----------------Distance from foundation--------------------Material-....----___._.___---_________.___...._--_----. ❑ No. ofcompartments-------------------------Size-------------------------------- Liquid depth--------------------------Capacity_-------------------- Dispos Field: Distance from nearest well._._ti$ ?__I_Distance from foundation___-_ 0.-.-_:._.Distance to nearest lot line—$7 r . 2----•-------------- Number: _ of lines-------------- Length of each line_____�__� --------____..Width of trench_--- Type of`filter material-------:5,1Z.-.....Depth of filter material------/__S__"-.....Total lengfh____,/_,cL_0---------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line.-.-_.-___.___._ ❑ Number:Iof pits----------------------Lining material---.--------- ----------Size: Diameter-----------1-----------Depth_------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__ -----------Ir--------------------- . F1 Size: Diameter----------------------------- Depth---------------- -----------------------------------Liquid Capacity----------------------------gals` Privy: Distance from nearest well ___..._---------------------------------.......Distance from nearest building......_--------___.______________._.-. ❑ Distance to nearest lot line----- ---------------------- -------------------------------------------------------•------- -------------------------------------------- Remodeling ------------------------•----------------Remodeling and/or repairi�9 (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, eStrafela , and.rules and regulations of the San Joaquin Local Health District. �(Signed)------ -------- --- - ----- ------- ----- ----------- - --- - '�_"_ ontractor) . r gy:. -- --- - =--------------------- s .(Title}. --- - (Plot plan, showing size of lot location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDI BY___ _ --- DATE._{�`�'---- -----` --- ------- --------------- - REVIEWEDBY--------- -- -- --- -------- --------------------------------------------- DATE---------------------------------------------------------- BUILDING PERMIT ISSUEDr - DA-TE----=-------------------------------------------------------- Alterationsand/or recommendations----------------------------------------- -----------•----------- ------------------------------------F--------------------•--•------------------------------- IM '11 -------------------------------- -- ---------------------------------------------------------------------{-- ---- ------------------------------------------------ ----------- r I ----------•---------------------------------------- ------------------------------- I --------- ...... ---------- ----------------------------- ------- ------- ----- ----------------- FINAL INSPECTION BY'. Date.- S- ----- -f----------- --------------------------------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT I j 1601 E.Nozollon Avert 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California i F.P.CC.