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FOR OFFICE USE: APPLICATION FOR''SANITATION PERMIT Permit No. ---------------------------------------------- - ---------------------- ---------- [Complete in Duplicate) 7�02� ---------------- 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 install the work herein described. This application is made in compliance with County Ordinanc o. 549. _ _ ___'-"--' �_ �--------------------- JOB ADDRESS AND LOCATION_______ ____ _ _______ Owner's Name---•-- � Phone Address.-•------------------- '"-------------------------------- ----------------- .._..... --- -- - ---------------- -------r------_--------- - - - - -' Contractor's Name----------------- ------- ------- Phone..14r. +� ' �°I Installation will serve: Res--sdence ❑ Apartment House ❑ Commercial frail r ur E] Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms -------- Number of baths a Lot size _1---- a_ ____________________ owl Water Supply: Public system [Community system ElPrivate E] Depth to Water Table _ ft. Character of soil to a depth of 3 feet: Sand E] Gravel ElSandy Loam [IClay Loam [:] Clay E] Adobe ,( Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ElNew Construction: Yes E] No [PO-THA/VA: Yes E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: [No septic tank or cesspool permitted if public sewer is available within 200 feet.) Oe t ank:� Distance from nearest well_________________Distance from foundation-___________-_____.Material---------------.--------------------------------- I No. of compartments.......... ---------------Size------------------ -------------Liquid depth--------------------------Capacity----------------------- s A ----------------------- D j, Id: Distance from nearest well. _ _ .__ _ istance from foundation.- --_-__.Distance to nearest lot�ine___S ________. LK' Number of lines_______ _________ Length of each line----- -Q_____- _____._.Width of french----.:o_-.-_--------.___-----.- Type of filter material____,S/ IAepth of filter material-----�,g-Fr___Total length___._____________. __�__.__!___ Seepage Pit: Distance to nearest eli�-_Distance fo clation---..'e_.,C�_1---Dista cp to nearest lot line_--_,S__.------ Number of pits---- ---------__Lining material_ r�-_Size: Diameter....,'� -----......Depth-----v2 ------------------- 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------------------------------------------ IT\Distance to nearest lot lire---------- ---------------------------------------; ---------------------------------------------- , Remodeling and/or repairing {describe}: .._ - ----- ------- ------------------------------------------------------------ ---------------------------- -----------------•-------------------------------------------------- - ------ ------------------------------------------- -------------------------------------------------- ----------------------------------------------------------------------------------------- ------ ----------------------- ------------------------------------ ------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to 4an�dJanregul ions of the San Jo uin Local Health District. �. i (Signed,)------ -------- ------ --. ---- -------------------- - -- -- - -- - Contractor) _[Owner and/or Co ar By:._.. ------------ ---reverse -------- ------- ---------------- By plan, showing size of lot, location of system in relation to wells, ildings, etc., can be plat d on reverse side). I FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- ------------------------------------- DATE-- 4r-7--------------------------- REVIEWEDBY---------------------------------- --- ------------------------------- DATE-- --------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------- ------------------------ --------------------------------- DATE------------------------------------------------------------- r Alterations and/or recommendations---------------- ------ -------------------------------------------------------------------------------•------------------------------ ---------- ------------------------------------------------------------------------------------- ------ ----------------------------------------------------- -------------------------------------------------------------------------------------------------------- ------------- - ----------------------------------------------------------------- ---- -------------------- r— FINAL INSPECTION BY:. . Date.---- f a .---------------------- ----- -------- SAN JOAQUIN LOCAL HEALTH DISTRICT , t f 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street e F Stockton,California Lodi,California Manteca,California Tracy,California F.P.a o.