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FOR OFFICE USE: 1_3-------- APPLICATION FOR SANITATION PERMIT .... Perm i t N os ---... w (Complete in Duplicate)r ----- ----------=----- r--------------- - ----------- -- lDate Issued ��"".-c��•��'-� -- -----„"„_-__„----_------_-.--- 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 L�OCATITIIO�N-------��--�"� ------�-"."P��---------------------------- -----------------------------------•---------------------- Owner's Name .�rf� r ----------------------------- - Phone ---------- Address-------•--•-------------�•�-'Z Y....-.__. - - sz Contractors Name------------------_1--------=�--------------- ------ Installation ----� r � ----•---------------------- Phone---�Vj5-A - ”"..""7 E Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -I----- Number of bedrooms .Z_- Number of baths --/---- Lot size _--_-- -------h--- -•----------•----------- r Water Supply: Public system R- Community system ❑ Private ❑ Depth to Water Table 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 E�J—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----------------- from foundation--------------------Material--------------------------:----------.----------- - No. of compartments--------------------_----Size--------------------------------:.Liquid depth---------- ------ --------Capacity.---------------------- 1 � �r Disposa Field: Distance from nearest well---Ao--------Distance from foundation.--/O-_--------Distance to nearest lot line-" ----""-------- Number of lines-----------/----------------------Length of each line-4q— o--3p r V✓idth of trench.___-".2" ""__--------------- ,. i r r Type of filter material----/Q-Q"� ft -"Depth of, filter material-----�_8 ""-."""Tota! length"""-""""2 Seepage Pit: Distance to nearest well----,1✓Q----------Distance from foundation---/__G"""_........Distance to nearest lotline___.f----------- -----Linin [?— Number of pits-----�--- --- g material--- Size: Diameter-----,;Ver-----------Dept h-----L. ___---------------- Cesspool: Distance from near1 est well""""."""""__"-_."Distance from foundation------------------- Lining material---""-"-.".-_---""""""".__"__"--_". ❑ Size: Diameter----- - --------------------- ----- -Depth--------------------- -----------------------------Liquid Capacity----------------------------gals. \ -Distance from nearest buildin Privy: Distance from nearest well 9 ❑ - k. Distance to nearest lot line--------------------------------------------------=- - Remodelingand/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 ri gulations of the San Joaquin Lo�al Health District. (Signed)-------------- ------------ (Owner and/or Contractor) By:--------------- I Title (Plot plan, showing size ofot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY 617 ------------ ; DATE-.- REVIEWEDBY----------------'-------•--------------- 3-------- --------------------------- -------------------------------------------- DATE----- ----------- ------------------------------------------ BUILDINGPERMIT ISSUED-------------------- ------------------------------------/------- t ---------------------- DATE_--------------------------------------•--------------------- Alterations and/or recommendatons:---. , ----------/`r---1-------- -----•--------- --------------- ------------------ -------------/---f---- ------ � �--- -------------------------------------------------------------- -- ------------------------------------------------------•---------------------------------------------------•----------------------------------------------- ------------------------------------------------- -----•----------------------------- ------------------------•-----------------------I ----------------------------------------------------------- ------------- ------------ ----------------------- ----------- -- --- --------------- -----— --- FINAL INSPECTION BY: Date------------- r "laG--------------------!'------------ ��- SAN JOAQUIN LOCAL HEALTH DISTRICT 1$01 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.R.co.