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FOR OFFICE USE: ------------------------ APPLICATION FOR SANITATION PERMIT Permit No. --------------- ...1-; ------ ----------- --------- ---------------------------- (Complete in Duplicate) --------------------------------- 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 w1ith County Ordinance No. 549. '],�� JOB ADDRESS AND LO ATION��.�l__-- � a„ C� --------- ��"`�------------. Owner's Name---__ - ---- v-q,_______�__ ti __ ------------------- Phone------------------------------------ - ------------------------------------------------ Address _^ -- ---- ---------------------------------------------------------------------------- Contractor's Name---- -------3 - Phone__. ---------- Installation will serve. Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _rr� Number of bedrooms ` ___- Number of baths _ _ Lot size --_+r2_J2__. '-.__-_______----__--_--- Water Supply: Public system ❑ Community system ❑ Private U4--Depth to Water Table _1-S__ ft. Character of soil to a depth of 3 feet: Sand ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date------------ ------) No Uq" 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.) Septi Tan -- ,y4-1I Distance from nearest well-----------------Distance from foundation--------------------Material----------------._.--------.--------------------- No. of compartments--------------------------Size-------------------------------Liquid depth------------------------._Capacity---------------------- e . .— Disposal Field: Distance from nearest welkre_..-__.-Distance from foundation__./�__.........Distance to nearest lot line_. 05--- Number of lines---------(___________________ Length of each line__e7 -----------------.-.Width oftrench--�-��-..11-_--------_-_--__ Type of filter material__`—� __Depth of filter material-18---- ------------Total length------ 'Q___________ _____ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line--_-.------ ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth-.-.---------------.------------- Cesspool: Distance from nearest well-----------------Distance from foundation....----------------Lining material--------------..____-_-____.--_-_._-_. S ❑ Size: Diameter------ -------------------------------Depth---------_--------------------------------------- --Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------_-----------------------------------------Distance from nearest building---------------------------------___-_----. ❑ Distance to nearest lot line---------------------------------- ------------------------------------------------------------------------------ - Y - ------------------------- Remodeling and/or repairing (describe)________ ______ ._ _ �____ _______ C`' ---------- - ---------------------------------------------- --••--------•------••------------------------------------------------------ -------- -----------/----------- r ---------------------------------------------------------------------------------------•-------•------•-------------------------------------•--------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------- -------------------------------------- -- --- --- --- -- 1 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) C .._ Owner and/or Contractor -- ------ --------------------- ---------------------------- - - --- ----- B ------------------------------------(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 Fr'/ --- -- - ----- -------------- ------------------------------------------- DATE------W_:!7 2' T ------------------------ REVIEWEDBY----------------------------------------------- - -------------------------------------------------------------------------- DATE_--------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------- ------------- ------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations-------------------------------- -------------------------------------- ---------------------------------------------------------------------_ ---------- --------------------------------------------------------------------------------------------------- --------------------- ------------------------------------------------------------------------------------ ----------------------------------------------------- ---------- -- --------------- - ----------------------------- --------------------------------------------------------- ---------- - -------- - J ---------------------------------------------------- - ---------- - --------------------------------------- --------- ----------------- ------ -------- .. � � FINAL INSPE - �j�.��-- - - ---- ------- ,� Date- -- 1---- ......- -- - _/--------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California