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A210.0 0 E USE ------------------------- _.--- _-_ APPLICATION FOR SANITATION PERMIT Permit-No. ---------------------- ------------------------ ------------------ (Complete in Duplicate) s "l(� 5 -._-_ This Permit Expires 1 Year From Date Issued Date Issued _____ ____ Application is hereby made to the San Joaquin Local Health District for a permit to construct and insFall the work herein described. This application is made in compliance with y�County Ordinance No. 549. JOS ADDRESS AND LOCATION__ �.___ __, _____ ____ _____ 1 -- i-( ,C�-� •---� _-- _- --_-.- Owner's Namey�_ ------ - ---------------`--------------------------- - ------------------------------------------- Phone----------•------------------------ Addres-------- 1_- _°--v` -----------------------------------------•---------------------------------------------------------.-_•••------------- Contractor's Name ` ---S-`------------------------------------------------------------------------------------------------- Phone--------------------------- ------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ t Number of living units: __/____ Number of bedrooms _3___ Number of baths _ --_ Lot size __ Water Supply: Public system ❑ Community system ❑ Private [Depth to Water Table 6_a_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay l!t]A obe 0 Hardpan ❑ Previous Application Made: (If yes,date_.------- `.___.._y No New Construction: Yes ❑ No A— FHA/VA: Yes ❑ No Kr TYPE OF INSTALLATION AND SPECIFICATIONS: ; (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ntk: Distance from nearest well-----------------Distance from foundation--------------------Material ________-__-____-_____--.-------------_-______- No. of compartments------.__________________Size--------------------------------Liquid depth---------------- ---------Capacify i Dispos F f Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- Number of lines-------------------------------- --Length of each line-----------------------------.Width of trench----------------------------- ----- k Type of filter material------.______________---Depth of filter material----____-___________._Total length---------------------------- ------------- Seepage �_--_____ See a e Pit: Distance to nearest well-/40 from fo d5 i nDiameter tante to nearest lot line_ P 9 ` �� r Distance -------- Q [ Number of pits.____.-----_- ----Lining material____' /.GIIZ/{ �c� --.Depth-_-o�•4r___-----________ a Cesspool:. Distance from nearest well-----------------Distance from foundation __---------.-------Lining material-------- --------- ___--________¢__ 7 ❑ Size: Diameter------------------------ Depth------ --------- --------------- --- --------- Liquid '.Capacity----------------------------gals. Privy: Distance from nearest well----____________________---_.__-.__.-.--_------Distance from nearest building--_________.___--------.-------------- -_ ❑ Distance to nearest lot lire------ ------------------------------ ------ - -•---------------------------•------- ng - -� Remodeliand/or repairing(describe):---------- ----------------- -----------------------------------•--------•-------------------•--•----------------------------------------------•---------f- --•• ----------------------------------•-----------------------------------------�-------------------------•------------------------------------------------------------------------------------------------------------------� ------------------------------------'-------------------------------------------------------------------------------------------------------------}----------------------------------•-------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. @ i (Signed)-----------------J ---------------- ------ -(Owner and/or Contractor) By:----- ------ . .: ---------------------------------------------------------------F (Title)---------- ------ ---------- ----------- ----------------------- (Plot pian, showing size of lot, location o system in relation to wells,'buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------ee!eof DATE-- ----------- .� REVIEWEDBY------------------------------------------- ----------;---------------------------------------------------------------•--- DATE----------- BUILDINGPERMIT ISSUED-----------------------------------I--------- -------- ° ------- ------ DATE------------------------------------------------------------- Altera+ionsGand/or recommidations----------- --- ------ - -----------•---••----------------------------------------------------------•----------- -------------------------- -" -- - -------�-- -------------------------- .-_...-__-6 _-------------------_----------- __.-___-__.-__.________-_-----------__-_.--___-___________-__.__-________________---_.-____-----_-______-- .__.___--.__-_-__------------- --------------------------- --------------- -___-___._.__________ ______________________________ ____„-------------------------------------------------------------------------_---------------.___..-----------------------------------------------____---.__________---._.__.-_ '. F FINAL INSPECTION' BY----"'----=-- Date-------------------- ---------------------------------------------------------- SAN JOAQUIN LOCAL HEALTH'DISTRICT i 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street r Stockton,California Lodi,California Manteca,California Tracy,California ' F.P.[:M