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FOR OFFICE USE: --------------------------------------------------------- APPLICATION FOS 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 Co my Ordinance No. 549. 16 as JOB ADDRESS AND ALO fAT N------------- ---- -------------------------- ------------•. ./.�./------- -- 4_-- _ --- --------------- Owner's Name ---- --------------------------------------- •-------••--------------------------- ---7---------------------- -------------- Phone r g AddressGSL o- � Contractors Name---- ------------- Phone------------------------------------ Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: (------ Number of bedrooms -3-- Number of baths �r---- Lot size -�` 3--. 7G Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table D 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 RrNo ❑ FHA/VA: Yes No [i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feeOt.)r �C Septic Tank: Distance from nearest well-4742-`-----Distance from foundation--l._------_-_. Material-- [ 'No. of compartments--_-_Z-_____----1-.-.Size--S __4_x` x_`�---Liquid depth------ capacity---� - _ - Disposal Field: Distance from nearest well_`-�'-d______Distance from foundation,"4!---___---__.Distance to nearest lot Number of lines---_�.,-___ ________________Length of each line/474,--;�- 'AWidth of trench--- -.P- --- -..--.--- - Type of filter material---- _/__aG -_..---Depth of filter matErial--I$"- _---------:Total length_---- 40V"-_- .-'�` .-:-- See a Pit: Distance to nearest we -----------Distance from foundation_-.Distance to nearest lot lin ---.- Number of pit - Lining materia ..Size: Diameter:---Dept h_--------. t C sspool: Distance from nearest well----------------Distance from foundation....................Lining material---._--------..----.-_--_-_--.-_----_ ❑ Size: Diameter------------------------- Depth-------------------------- ----- - ------ --------- Liquid Capacity----------------------------gals. Privy: Distance from nearest we]-------------------------------------___.........Distance from nearest'building------ .------ .-----_-----..-----.--.-. ❑ Distance to nearest lot line---- ------------------------------------------------- ------------ -------------------------------------------------------- Remodeling and/or repairing (describe):-- ------ ------------------------------------------------------------------------------- ------•------------------------------- ------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------- --- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - --- I hereby ce/1a , t I have prepay d t is application and that the work will 6e done in accordance with San Joaquin County ordinances, Statan rules an a ations the San Joaquin Local Health District. -------------------------------------------------- ---------- Owner and/or Contractor)___._- ------- - ------ -- --- - By:---------------------------------------------------------------------------------------------------------- ------------------- -----(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 ACCEPTED BY.........• ------ DATE------------ "� � - •.._. •------------------- REVIEWEDBY- ------------------------------------------- ---------------------------------- ---------- --------------------------------- DATE----- -------------I---------------------------------- BUILDING PERMIT ISSUED-------------- -----------------------------------------------•--------------------------------------- DATIL---- -------------------------------------------- Alterations and/or recommendations:---------- ........... ----------------------- ----------------------------------------------- °------------------------------------------------------- ------------------.-------------------------------------------------------------------------------------------F-------------------------------------------------------------------------------------------------------- -------.-..-..--------------------------------"------------------------ ----- ---------------------------------------------------------------------------"-----------------------------_----------------------------- -_ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -- FINAL INSPECTION BY--------- ------- /.r-_- Date------------ - i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore StreetWest 91h Street Stockton,California w Lodi,California Manteca,California Tracy, Qlifornia F.F.C a. - 1�•.`