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FOR OFFICE USE: s>-'_ t t Permit No. _-_-__--_----_____---.,:_-___`7 -------- ----------------------------------- -_____-- APPLICATION FOR SANITATION PERMIT ---- --- ---- -- (Complete in Duplicate) S! 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 Ordinance No. 549. 2 ADDRESS AND LOCATION_ pox` `f��? �� — C� 7,,?- JOB �� 7 --------------------------------------------------- ------------------------------------------------------------- --------------------------- Owner's Name----------------------------------------•----•------------------------------------------------------------- -- ----- Phone------------------------------------ - ------------------ Contractor's Name atm Phone."1?�'E -'3 Installation will serve: Residence [!TApartment House ❑ Commercial ❑ Trailer Court ❑ M?tel ❑ Other ❑ Number of living units: -__4 Number of bedrooms _3--- Number of baths __/_- Lot size ------SQ'ctAg"4-------------------------- Water Supply: Public system ❑ Community system ❑ Private [B- Depth to Water Table J�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ardpan ❑ Previous Application Made: (If yes,date------._ --------- ) No ©—. New Construction: Yes ❑ No [4—"FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) C.Se tic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material--------.------.------.-----.-.--_---_---------. l a0Q No. of compartments------------ ---- -----Size-------•-------•---------------Liquid depth-------------------------.Capacity-•-•------------------ r osal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line................. 7� Number of lines------------------------------------Length of each line------------------------------Width of trench--__.----__.-._-.--_----_-_-----.-. Type of filter materia's-------------------------Depth of filter material------------------.----Total length----_---_-___-_-:-_-_---.--_----_---_--- Pit: Distance to nearest welllAA- ..........Distance rom foundation_-- Distance to nearest lot line_/D_U__. C9-- Number of pits.-_.-/---------- ---Lining materialSize: Diameter----3-3_.__......Depth_ ...d_:S7__----_-__-.----� Cesspool: Distance from nearest well ----------------Distance from foundation----------------- _.Lining Material__--___-_-_-------------_--___----- 1� ❑ Size: Diameter--- -------------- ----------------Depth---------------- --------------------Liquid Capacity----------------------------gals. (O Privy: Distance from nearest well-_-_-_--_-_-_____--------------_____ _-_ -_Distance from nearest building.-_-_ ---------------------------_-----. ❑ Distance to nearest lot line- _---------------------_----------- ------------------------------------------------------------------------------ -----------__ 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 County ordinances, St a laws, and rulep and regulations of the San Joaquin Local Health District. (Signed) - ---------- --------------------------------------Owner and/or Contractor) By: - ( )--------- -- --< --------------------.--- (Plot plan, showing size of lot, location of sys+errf in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----- --- -------------------- --- ---------------- -------------------------------------- DATE-- ----------------------- REVIEWEDBY--------------------------------- ---------------------------- -------- - --------------------------------------------. DATE-------------------------------------------------- _ BUILDINGPERMIT ISSUED-----------------------------I---- - ,--- DATE.-------- -------------------------------------------- "7 -�_:?_�_.1- Vic:"� c c-c"' _?r Alterations and/or recommendations:---.---.----` .f._ /-_-.-- .-_-- --------- -.- ------------< �= �--- z.....----- `` C --------------------------------------------------------------------------------------------------------------------------------------- -------- ------------------------- -------------------------- --------------------------------------------- ---------------------------------------------------------------------------•------------------_------------- ----------------------- ----------------------------- ------ -------------------------- ------------------------------------------ -------------------------------------------------------------------------- --------------------------------------- ---------------.----------------------------------------- ------ --------------------- ------------------------ ------------ ...---------------------------------------- --------- ----------- ---------------------------------------- -- FINAL INSPECTION BY:----- � ,-.___- _.-_ ---_. Z_�->�_ - Date----------`�� 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.