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rVKUrtica U5E: --------------------- ------ -- -- - ------ --------------- - - ------ -------- -- APPLICATION FOR SANITATION PERMIT Permit No. ._f�x.q� (Complete in Duplicate) -- ------ -------------- This Permit Ex fres 1 Year From Date Issued � Date Issued . 1 Application is hereby made to the San Joaquin Local Health District for a permit to construct at e d all the work herein described. This application is made in compliance with County Ordinance No. 549. � .• oos--asp--z3 JOB ADDRESS AND LOCATION_ __ _____________________ ` . -------------- ------- _- Owner's Name-_____�� - -- ------- ------•----------.-------------- Phone =....._ Address----------- �!'tf ---------- Contractor's Name.... ------------------------------------- - __.._ , -----------•------------------------ ------------ ----•------------- ----------•--- Phone__.._.....__.-----•----•------...._ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._`---- Number of bedrooms J-----. Number of baths I_--_ Lot size Water Supply: Public system ❑ Community system ❑ Private ® Depth to Water Table.?.Q-. 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 No ❑ FHA/VA: Yes F1No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: " '(No"septic tahVorcesspoolpermitted #public sewer is available within 200 feet.f-4 Septic Tank: Distance from nearest well-----------------Distance from foundation------------------- Material = No. of compartments Size------------------ ------Liquid depth.--- - Capacity---------------------- sal Field: Distance from nearest well-----------------Distance from foundation___________°__-__.Distance to nearest lot line_________________ 0 Number of lines--------------------- ----- --=-Length of each line------------------- ------.Width of trench--------------.--------------------- rq �`c Type of filter material_______---__--- -----_Depth of filter material___.__.-__ ----------Total length-----------------:------------=----------- Seepage Pit: Distance to nearest well---_-d`____4_-----__-Distance from f undation__.�.0 Number of pits__- -_______- �1� ' -.......Distance to nearest lot line_--4" _______Lining material_;,F__'_'_rr_`_�_il._____._.Size: Diameter_-_-_ �� 'w Depth_. -------- -- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------- material-- Ib Cl 1 ---- 0 Size: Diameter--------------------------------------Depths`------ ---------- - ----- -- _ -----------------Liquicl Capacity-- ------------------ -----gals. D Privy! Distance from nearest well___________________________ ---------------------Distance from nearest..building______._________-_--___ Distance to nearest lot line__________________ _ � Remodeling and/or repairing (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, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)_-- ------- --- ---- --- ---- --- .� --------------------------- -------------------------------------(Owner a r ------------------------------- -------- and/or Contractor ---- --- 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_- VIEWED BY --------------------------------------------------------- DATE----- _'_ ''_. /-------- ---- ----------------------- - ---------------- ----- ----- DATE BUILDING PERMIT ISSi.IED------ = -------------- ------------•--------------------------------------- DATE-------------------------------------------------------- -----------and/or recommendations:---------------------_--_-- - ------�-�- -------- ------ -- ----- ------ ------- - ---------------------------------------------- r FINAL INSPECTION - ----- ---- --- Date---- ------ --- SAN JOAQUIN LOCAL HEALTH DISTRICT r.r 7601 E:Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REViSEO 8-S9 3M'3"63 F.p,C O.