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FOR OFFICE USE: ____-_._____._____ APPLICATION FOR SANITATION PERMIT Permit No. --------------------- -�----D- ------------ (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. JOB ADDRESS AND LOCATION ......q / �L------------------------------------------------------------------------- Owner's Name----------------0-G e-1...------ + JxI J_�d d -- Phone------------------------------------ Address10-o k...F,o ..... 11IGC,---Z-�--------------------------------------------------------------------------•-----------•------------------------ Contractor's Name-------------- ----------d-------------------------------- ----------------------------------------------- Phone----------------------------------- Installation will serve: Residence 2--_A-partment House ❑ Commercial ❑ Trailer Court ❑ Motel [3 Other ❑ Number of living units: -1----- Number of bedrooms -,�--- Number of ba hs J---- Lot size --------�___��-�_______________________________ Water Supply: Public system [:] Community system E] Private epth to Water Table �.3 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 [D/Idew 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 T Distance from nearest well_________________Distance from foundation--------------------Material------------------------------------------------- f `L �7J��No. of compartments------------------------Size-------------------------------Liquid depth-------------------------Capacity----------------------- Disposal I : Distance from nearest well-_ 101___._Distance from foundation._..1_-G_!-------Distance to nearest lot line--- ........... En'126'3 Number of lines---------------/------------------Length of each line--------LG_a`-_-__----.Width of trench------- -'-------__-_-.____-_ Type of filter material-_I�i+ ____Depth of filter material____Z-�°`--------Total length---------&R:2�_____________________ 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 ------------------- --------------------------------------•--------------------------_----------------------------------------- Remodeling and/or repairing (describe):-- -----------------------------------------------------------------•------------•---•-----•-•-----------•--------- -------•--------------- - -----------------------------------------------------------_---•-------------------------------------------------- ----------------------------------------------------------------------•---•----------------------------- ----------I----------------•------------- ---------------------- •----------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ ----- ------ -------------------------------------------•------------------------------------------------------------------•--------------------------------- ----------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State la and ru and regulation he San J n Local Health District. (Signed)----- -l- ------ - ------------------ ----(Owner and/or Contractor) By:-------------- - ------------------------------------------(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--------- 4 - ---------------------------------------- DATE----------- ------------------------ REVIEWED BY-------------------------------------------- ------ DATE_----- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------------------------------- Alterations and/or recommendations:---------------------- -------------------------------------------------------------------------------------------------------------------------- ------•----------------------------------------------------------------------------------------- ------------------------- --------------- ----------------------------------------------------------- -------------------------------------------------- ---------------------------------------------------------------------------------------- -------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------- --------•--- -------------------------------------------------- ---------------------------- --------------------------------------------------------------------------------------------------------------------------------- ------------ FINAL INSPECTION 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.a.co.