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FOR OFFICE USE: ------------------ ------------------------------- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _ .lfo._....� --------------------------- -- ------------------------ (Complete in Duplicate) Date Issued ------------------ ----------------------------- 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. � p JOB ADDRESS AND LOCATION ?�_� 1�'9_ _ !4.4_'--e ---------- ______________ Owner's Name = ------ Phone ----- 1 -- Address f.tl�._� �`�'e - --- `-------------------------------------------------- Contractor's Name---- - --••%� .. ------ Phone................................... Installation will serve: Residence d Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I___ Number of bedrooms 3---- Number of baths y_ Lot size ---------------------------- Water Supply: Public system ❑ 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 ❑ 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. _-----_- .-__--_.-_---._--__-__.No. of compartments--------------------------Size--------------------------------Liquid depth---------..---------------Capacity------.---------.------ 0 Dispos Field: Distance from nearest well.---4_*'__._Distance from foundation..//!--/.......Distance to nearest lot line_F._._.....-_ EK Number of lines__--_.____/-______________________Length of each line----- _eO.................Width of trench-----7-_'----------------------- Type of filter material...... t�_---------Depth of filter material------,/_f__".._._..Total length----1�1p._�______________________ Seepage Pit: Distance to nearest well.---------------------Distance from foundation____-_-.-___._--___.Distance to nearest lot line----------------- F1 Number of pits----------------------Lining material__-__-.-_-.._..-___-__.Size: Diameter------.----------------Depth-..---.-_---_.--_---__-_-------.- 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_______-_---.______-__________._..--___.-. ❑ Distance to nearest lot line -------------------------------------•----------------------------`--••----------------•----•--------------•------------------- Remodeling and/or repairing (describe)______________ ____ _ -_-__--_--__.___ --------------------------------- , __ 6 :_ ; __::::_:_____:_____:_ --------------•----------- \�7 ----------------------------•-------------------------------------------------------------------- ----- ------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat rTls, and rules and regulations of the San Joaquin Local Health District. (Signed) - -- ------ -- ------------------------------------1---------------------- -------------------------------------( * and/or Contractor) NA BY� __ (Title) (Plot plan, showing size of lot, location system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._.. ? - - - - - -- --------------- ---------------------------------------- DATE BY---------------------------------------------------- ------------------------------------------------------------------------ DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------------------- --------------- Alterations and/or recommendations--------------------------- ------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------------------------------------- -------------------------------------------------------------------•-------------------------•--------------------------------- ------------------------------------------------------- ----------- ------------------------------•----------------------------------------------------------------------------------------- ----------------------------- -------------------------------------------------------------- ------------- ------------------------------------------ -----------------....--------- --. ------------- ------------------------------------------- ---------------- ------------------------ ------------- ------------------- -------------- ------------------------------------------- --------------- ----------------------- --- --------- ------------------------- FINAL INSPECTION BYE% . Date C --e7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.c o.