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FOR OFFICE USE: � ?, )- ,-,3 0 1 11 1-17 --------3 ------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ---------- (Complete in Duplicate) Date Issued02 . ------------ This Permit Expires I Year From Date Issued ---------------------- ."" �.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 compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION_%V0.-,h%,',_qt4 6------ ---�-. ---------- Owner's Name-_-Ae ... ----------- -- ------------------------------ ------ Phone----------------------------------- Address-- .......................................................................... Phone----------------------------------- .............. .... ------ Contractor's Name___t�. _ Installation will serve: Residence [A/Apartment House E] Commercial E] Trailer Court [] Motel 0 Other 0 - 10 A Number of living units: __1---- Number of bedrooms__. Number baths -- Lot size -- -X--- Water Supply: Public system El Community system Fl Private E!r Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand [] Gravel [] Sandy Loam El Clay Loam 0 Clay [:] Adobe[)/Hardpan 0 Previous Application Made: (if yes,date---_-_- ----- No M New Construction: Yes ❑ No Ej FHA/VA: Yes E] No 0 TYPE OF INSTALLATION AND SPECIFICATIONS: (No Septic tank or cesspool permitted if pu44c,sewer is available within 200 feet.) Septic Xnk: Distance from nearest well.-_- Distance from foundation-------11-------Material------ -------------- No. of compartments-------y------------Size ...---Liquid depth----4--f ------------Cap a�,_ity. ioo_ v.a. Z, Disposa ield: Distance from nearest well-_50. Distance from foundation /-0--/------Distance to nearest lot line.7 .......... Number of lines--------------3------------- ---Length of each line---------5ry---------------Width of trench---- ------- Type of filter material--------SAP---------Depth of filter material------1-19...........Total length._-._.—&-- ....... Seepage Pit: Distance to nearest well_._._._....---------Distance from foundation....................Distance to nearest lot line--------- ------ F-1 Number of pits------------------ ---Lining material----- ----------------Size: Diameter------------- ----Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material....-____------___--...__--__..... ❑ aterial------------------------------------ F1 Size: Diameter---- --------------- ----------------Depth----------------------------------------------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well----------------------------------------------.-Distance from nearest building--------- -------------------------------- F-l Distance to nearest-lot line-------------- ---------------------------- -------------------------I----------------------------------------------------- ---------------- Remodeling ------------_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, St ws, and rules and regulations of the San Joaquin Local Health District. and/or Contractor) (Signed)- --- ---- -- ------- --- ---------------------------------------------------------------------------------- y -------------------------------------------------(Title)-------------------------------------- -- - - ------ --------- 4 B (Plot plan, showing size of lot, loca,tSion 4ofystem in4liation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------- - ----------- ------ ------------ DATE----------- _��=----- ----------------- ------------------ DATE----- ----- -- ------------------ ------------------------- REVIEWEDBY------------------------------------------------ ------------- --------------- -------------- ------------------------ ----- . BUILDINGPERMIT ISSUED----------------------------------------_------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations--------------------------- ------- -- -----------------------------------------------------------------------------------------_ -------------------------------------------------- ------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------I-------- -------------------------------------------------•-•------ ----------------------------------------------I...I------------------------------------•------------------- ---------------------------•----- --------------- ------------------------------- ----------------__---------------------------------------------------- ---------------------------------------------- ------------------- ------------- ------------------------------------------------------------------------------------------- -=--3 14- -- FINALINSPECTION BY:.-.,/( _(C_—------------------------------- Date------------ .? Z_------ --------------- ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelts"Ve. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California_.. F.P.00.