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vrri�,t �jt; ---------------------------- -------------------- APPLICATION FOR SANITATION PERMIT Permit No. --- ---- -- ------- :(Complefe in Duplicate) . This Permit Ex ires I Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit t This application is made in compliance with Couo con truct and install the wort herein described. nty Ordinance No. 549. JOB ADDRESS AND LOCATIO- Owner's Name-------------- -- --------- '----�-- -------. --- ----�--- ---- -- Address--- ----- ------------- Phone •---- '4:- -; G ----------------------------- - --------- ----_------- Contractor's Name-..-- --•----------- ••-•-------------------------- Installation will serve: Residence Apartment House ❑ Commercial ------------------------------------ --------- Phone---- --•------------• Number of living units: _ _.0-- Number of bedrooms _ _ ❑ Trailer Court ❑ Mofee Other ❑ Water Supply: Publics stem Number of baths __ _- Lot size ------ --1. PP y' Y ❑ Community system [ Private ❑ Depth to Water Table&P ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam / Cla y ❑ Adobe Hardpan 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 well-----------------Distance from foundation----------_-. -.- Material__-- ____---_-....................... ❑ No. of compartments------------ --- ....... /L Size -------------------------- -------------- -------Liquid dept}- ------------- ------ ---Capacity.----- ------------ Dispos�l'�Field: Distance from nearest well..____ T_Distance from foundation- -._ ..- � �� Number of lines--------------- -- - - --- Distance to nearest lot line----- ___-f --.---Length of each line---- ------- -- l Type of filter material _ ---- Width of french-_______ _--- -Depth of filter material.-_-___/- �.._--Total length-----.-__--- ' j See a e Pit; _ p g Distance to nearest well-_____- -------------Distance from foundation--------------------Distance to nearest lot fi _-_--_ Number of pits---.-- --------------Lining material--_.__---------------- Size: Diameter-------------- ------- Depth------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material--__-.-_---.------_ ❑ Size: Diameter- ---- -- --- ---- -------------_ ---------- ---Depth--------- -- --- --------------------------------Liquid Capacity-- ---- ------------------- al Privy: Distance from nearest well_____ ___---- ... g � --------------- ----Distance from nearest building-------------------- ❑ Distance to nearest lot line_._ _------. ------------------------------------------------------ ----- - Remodeling and/or repairing (describe):----- -------- f -------------------------- ------------------------ ------------------------------------- ----------�. -.------- ------------------------------------------------------------------ ----------------------------------------------------- I hereby certify that I have prepared this application and thaf 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)----------- -- Pon -- Owner and/or Contractor] By:.--------- (Title) (Pl of plan, showing srze of lot, oca ion o� 'stem rn wel'afion we s, buildings, etc., can be ace reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -._�iC'-C� __-.-._..__---_-..- REVIEWED BY ---------- DATE---------- •----- `_ -------------------------------- ---- -- t�f l-- ------ ----------- -- -- -------------------------- - - DATE_ - ----- - UlLDING PERMIT ISSUED--------------• ------- __ _ --- --------------- -------- -- --------------- ---- ---- Altera#ions and/or recommendations: __ - -------------------------------- ATE------------------------------ --- ----- ------------- ----- r --------------------------------------------- ------------------------ ------------------ ---- -------------------- - - --- ------- -- �' - - --------- ---------------- - ----- ---------------- ------ -------------------- FINAL INSPECTION BY:..____-t--- w o ------- --- Date_. -- ------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellen Ave. 300 West Oak Street 124 Sycamore Srreet Stockton,California Lodi,California :7 "� 20$West 91h Street �" Manteca,California Tracy,California i