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FOR OFFICE USE: ----------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ----------- // --------------------------------------------------------- 1- ------ -- ------- '------------------------- (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 coiDpli nce with County Ordinance No. 549. f�,a�•1 7_.�2-0 CL_ a; JOB ADDRESS AND LOCA ON_'� .., d �� ar --------POP`---------- Owner's Name-------------- --- -------h_Q-----H---------- ----------_.... Phone------------------------------------ --- ------- p � -------R EALOA/--------------------- ---------------------- Contractor's Name----- W_&E�K --.--- . Phone----------------------------------- Installation will serve: Residence E!r Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j----- Number of bedrooms _•-�__._ Number of baths _ ___.__ Lot size - _ _Rc ------------------------- Water Supply: Public system ElCommunity s stem E] Private /Depth to Water Table 3-E ft. N -r, . Character of soil to a depth of 3 fest: San Gravel E] Sandy Loam E] Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ fn Previous Application Made: (If yes,date____________________l No,�New Construction: Yes E] No g?11HA/VA: Yes PT""iNo TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tT -- Se tic T k: Distance.from nearest wel "� Distance frog' foundation-___� _.__._ Materia No. of compartments ` p p Size /� x 3 Liquid depth . Capacity._._/r7_. Disposal Field: Distance from nearest ell-- ......Distance from foundation----/0........Distance to nearest lot line--�__ _.__.. [}� Number of lines----------------- -----------------Length of each line------ -,-----.Width of trench......... - ----------------- Type of filter material___A0.!0'r-.__Depth of filter materiai_____1- ------- ._ Total length 0 ------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line..____._____ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter.----------------------Depth----------------------- ----- Cesspool; � Cesspool: Distance from nearest well--------_------_Distance from foundation._._._._._.______.Lining material___________________________ ❑ Size: Diameter-------------------------------------Depth--------:-------------------- ------ - ------------ Liquid Capacity------------------------- Privy: Distance from nearest we]L_________________________________.__.-____._.._Distance from nearest building --------------_----- t ❑ Distance to nearest lot line----------------- ----------------------------------------------------- ------------------------------------------------------- --Remodeling and/or repairing (describe)------------------ --------------------------------•--------------------------------- -------------------------------------------------------- --------------------------------------•----------------------------------------•---------1 ------------------------------------------------------------------ ------------------------------------- ----------------------------------------•-----------------------•------•--•------------------------------------------------------ ----------------------------------------- ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. r (Signed)----------------------------------------------------------------------------------------------- ------------------------------------- ------------ --------(Owner and/or Contractor) By:--- ---------------------------------------------------------------------------------------------------------------------------__(Title)-- --- ------ - ------ y„ _ (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 ` ` DATE3 __-.:----------------- REVIEWEDBY--------------------------------------------- ----------------------------------------------------- ------------------------ DATE------------------------------------ •- ---------- BUILDING PERMIT ISSUED------------- ------------------------------ --- DATE----------- ----- �`_ Alterations and/or recommendations:_-........................... ------- -I--------------------------------------------------------------------•-------- --------------------------------------- ---------- ---------------------------------------------------------------------------------- ------I------------------------------------------------------------------------------------------------------------------ ------------------------------------ -------------------- --------- ------------ -- - FINAL INSPECTION B Date----------.�. .� _(t? .-- -- ------- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street i Stockton,California Lodi,California Manteca, California Tracy,California E Z;