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FOR OFFICE USE: 71 APPLICATION FOR SANITATION PERMIT �� --------------------------------------------------------- Permit No. ............... (Complete in Duplicate) / ___..____-_____-__._._-..______-_-___--------------- This Permit Expires 1 Year From Date Issued Date Issued _ ______..t�L.-_. 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 compliancy with County Ordinance 549. .... II ..�- f JOB ADDRESS AND L ATION Z' 'kc,t4 ._.. J " '` Owner's Name______._ 7krt --- --------- --------- --------------------------------- Phone---- ............. hd Address- 3 --------- ---- ---.. r Contractor's Name-- ' ------ ------ -•---------------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel E] Other E]Number of living units: __1-__- Number of bedrooms4--- Number of baths l-_-__ Lot size ---' � ---------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] 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. of compartments--------------------------Size------------------------------.Liquid depth--------------------------Capacity----------------------- D ---------------------- Disposal field: Distance from nearest well._..$P_�__._Distance from foundation......,��1_____...Distance to nearest lot line____ ____. Number of lines------------1.__�_�sj� Length of each line---�t?�_�___-_-_`--__---.Width of trench-_2__--__�____________________ Type of filter material------tfr+7Vel-.___Depth of filter material-------�_?_._.......Total length------JANP_________________________ 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--_____.--.-_--_--.--_.-___-__-_-_. ❑ Size: Diameter ---------------=----- -- - ----Depth------------------------------------------- --------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building_-___.________-_-_________.____.___. ❑ Distance to nearest lot line----------------------------------------------------------------------- -------------------------------------- -- w Remodelingand/or repairing (describe):-------------------------------------------------------------------------------------------------------------------------------------------------------- •---•-•--------------•-------------------------•------•-------•------------------------•-----------•--- ---------------------•- --------------------•-•----------------------•----------- ---------------••-------------------•--•----------------------------•----------------•-----.-----•--------------------- --------------------------------------- --------------------•----------------------------------; ---------------------------- -------------------------------•------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State and rules and regulations"of the San Joaquin Local Health District. (Si ned 9 )-------------- ---------------- - `,- ---------- -----------k--------------------------------------------------- ------•----------------- and/or Contra By:----------- Q-•-- ==-' *------ ----------------- --- -------------------------------- - (Title) -- --- --- (Plot plan, showing size of lot, location of s tem in r tion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---------------------------------------------- DATE....�'13..'C------------------------------- REVIEWEDBY--------------------------------------------- -------------------- ------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-----_-_------- ------------------------------ --------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations-------------- --------------------- --------------------------------------------------------------------------------------------------•------------- --- ----------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------- ----------------------------------------------------------------------------------------------------------- ------//-------------------------------------- ----------------------------- w .__------ Date__-C__'.^'�__--'--�. FINAL INSPECTION Ar,---------------- --- ---------------------------------------------------- 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.CO.