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FOR OFFICE USE: ------ -------------------------- APPLICATION FOR SANITATION PERMIT Permit No, a .La. ... ------------------------ -- -- --- ----------------- (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. 007 _ ctcpp_z� ,1Z t!7(,,7 A) - Ec.L-i O JOB ADDRESS AND LOCATION.---------- mac-----�..-h'` yil h---t�,� ,` lc� --- r . _Owner's Name 4 � --------------------------G-'__----- --------------------------- -- ---- ---- Phone------------------------------ Address---- ti y! � � � .-------------------------------------------- Contractor's Name----- ------------------------------------------------------------------- ---------------------------------------- Phone----------------------------------- Installation will serve: Residence T Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: L------ Number of bedrooms __Z__ Number of baths _/_____ Lot size _P -/lac_____________________________________ Water Supply: Public system ❑ Community system ❑ Private M Depth to Water Table 9b-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam] Clay ❑ Adobe❑ Hardpan r 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 weal_________________Distance from foundation--------------------Material______.._._.___.__.__-.__-_.____.._.._______.__. ❑ No. of compartments--------------------------Size-----._------------------------Liquid depth--------- Capacity----------------------- Disposal Field: Distance from nearest wellA_c-_,.------Distance from foundation----/_Q---------Distance to nearest lot line_: _________ Number of lines-------/----------------__________Length of each line____-CCV--__-____-.___-._.Width of trench_. _7f__',__..__ _____.____ Type of filter material_--!Jtf---------------Depth of filter material----/_9_-----------Total length_-4_v.'--------------------------------- Seepage -- ---- ------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------------------- -11! El Size. Diameter- -- ----------- ---------Depth----- -------------------- ----- ______._.._______Liquid Capacity --------- --- - - -----9als. r �r Privy: Distance from nearest well-----------__-----------------------------------Distance from nearest building------------------------------------------ �_31� ElLDistance to nearest lot line------------------------- --- - ------------ - ---------------------------------------------------------------------------------------------- '' Remodeling and/or repairing (describe):------ ----------------------- --------------------------------------------------------------•-------------------------------------------------------- --------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------ ID I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, yState - laws, and rules and regulations of the SJoaquin Local Health District. (Sigma) f ff ----- --------------------------------------------------------------- (Owner and/or Contractor) BY:----------------------------- — r---------------------- ----------------------------------------(Title)---------- ---------------- (Piot plan, showing size of lot, locatio of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - --- __y / --- ----------------------------------------------- DATE--- -1`� G - ---------------------- - REVIEWEDBY--------------------------------------------- ------------------------------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------- -----------------------• -------------------------------------------- DATE------------------------------------------------------------- Alterationsand/or recommendations:-------------- ------------ ---- - ------------------------------------------------------------------------------------•----------------•------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- ------------------------------------------ ---------------- --------I------- -------------------------------------------------------------------------------------------------------------------------------------------- -----------------------------------------------------•------------------------------------ ----- - -- -------------------------------------------------------------------------------- ----------------------..-------- ----------- ----- -----------------------------I---------------------------------- ------------ --------------------------------------------------------------------- ------------------------ FINAL INSPECTION - ----- Date � � ----------------------- ------------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Avg, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.a,c o.