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FOR OFFICE USE: --- --- -- -- = o 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. JOB ADDRESS AND LOCATION--------- .I---------• 1 /--------------------------------------------------------------- �...� <� Phone-- Owner's Name----------- Address-----•-------------------- it..---- �1.__ _. C /li -----------W—All-------------------------•--------------•-•------------- .... Contractor's Name - l .f_. ."-/- ------ cam'-------------- ------------ Phone ------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/.___ Number of bedrooms __ — Number of baths __I___ Lot size --- 1- -- ----------------- Water Supply: Public system Vommunity system ❑ Private ❑ Depth to Water Table _ - ft. y Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Vg Clay ❑ Adobe❑ Hardpan p Previous Application Made: {If yes,date--------------------) No ®./New Construction: Yes El No �A/VA: Yes ElNo [ ' TYPE OF INSTALLATION AND SPECIFICATIONS: I (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. of compartments-------------------------Size---------------------------- ---Liquid depth----------- ---- ---------Capacity------------------- -- Disposal Field: Distance from nearest well------------ --Distance from foundation-------------------.Distance to nearest lot line-______.___-_-_ ❑ Number of lines---------------------- --Length of each line-----------------------------.Width of trench--------------- ------ Type of filter material-------------------------Depth of filter material-----------------,-----Total length------------------------------------------ Seepage Pit- Distance to nearest well------- - --------Distance frog foundation_&Q_/!��Tistance to nearest lot line-_ Number of pits------./---- --------Lining material__S_�P" -Size: Diameter- 47.0-'��----__.Depth_..c��`��.______.. Cesspool- Distance from nearest well________________Distance from foundation-------------------.Lining material------------____--_____.__-_.-.---__. ❑ Size: Diameter--- ---------------------- - ---------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------------- -------------Distance from nearest building------------------------------------_..._. .' ❑ Distance to nearest lot-line-- -------------- Remodeling and/or repairing (describe):....__ -_.-- --- �f--------- 1 / �Y G�. rn' ] --------------•-----------------------------------------------------------------------------------------•-------------------•-----------=--------------------------- ------------------------------------------------------ 1 ' -----------------------------------------------------------------------------------------------------------•------------------------------------------------------------ ----------------------------------------------------- --------------------------------------------------------------------------------------------•-:-------------------------------------------------------------------------------------------------------------------- ------- C I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State [aws, and rules and regulations of the San Joaquin Local Health District. l (Signed)------- ----- f ./�'--�_ _/- -- -------_ � . --------------------- - wner nd/or Contractor] �l BY: ----------------------------------------- - = Title)--- --- - _------- ----------- ------- I (Plot plan, showing size of lot, locatio system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------------------------- ------------- 5------------------------------ ----- DATE---------- l p E REVIEWEDBY---------- ----------------- --- -- ---------------- ---------------------------------- DATE---------------- ------------ ----------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------ -------------------------------------------- DATE--------- ---------------------------- ------ --------------- Alterationsand/or recomtn ndations-------- -------------------------'-------- --------------------------- -----------------------•--------------•--•----------------•--------------------------- -----------------•- ------------------------------------- - --------------------------•�e --- - 5-- � ----- -- ------ ------ ------------ ---- -------- ------- ------------------- -----• ----------- ----------- FINALINSPECTION BY--------------------- ------------------------------------------ Date__.....------------------------_ ------- --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.I{at:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ` F.P a. l �.