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FOR OFFICE USE: -- ------------ -------- APPLICATION PPLICATION FOR SANITATION PERMIT Permit No_ .................____-_ (Complete in Duplicate) 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. _. C _r _. ) � � } _ t.r sr -------------- JOB �- — JOB ADDRESS AND LOCATION____ : -- ----- -- - --- Owner's Name --- --------- -- ----------- 0,' \ Phone Address------------------------------------------------------ --- -- ---- ------ ,r--- - ----- ----------- -- - --- Contractor's Name----- ------- ------------ n--('_j 1 ( - �" ------------------------------------------ Phone Si' zL = Installation will serve: Residence " Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----C Number of bedrooms _72--- Number of baths __(___ Lot size ___4_ '_6-'___ `\_t_�:__ _°__-__._ ------ Water Supply: Public system -❑.. Community system-9 Private � Depth to Water Table*'/k_._ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam D� Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date__ ___ ___ -__ __) No New Construction: Yes ❑ No FV FHA/VA: Yes ❑ No 1 TYPE OF INSTALLATION AND SPECIFICATIONS: j (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---------- ___________ Disposal Field: Distance from nearest well .__-- Distance from foundation---!V - -,_-_.Distance to nearest lot line__"':"----------------- F Number of lines__._________------(_______------Length of each line---------- ->9- ...............Width of trench-------- ---------- Type of filter material__S Zo-4-N_Depth of filter material___ �_ _ _Total length______ �^i__ __- - _.- 1 Seepage Pit: Distance to nearest well___ _---------Distance frorrhfoupdation � _.Distance to nearest lot line '�(" L- Number of pits-.-__ _.__ ___Lining material---- t_c0-{� _t.-.Size: Diameter _ 3 _ _.____Depth_ .'_ -------------- Cesspool: Distance from nearest well--------- --- _-Distance from foundation --- Lining material-----.------- ----------------------- U1 11pSize: Diameter_ -_ ___ -- ------------------------De th-----------------------_.---- -- --------------Liquid Capacity q - -- ------------------gals. Privy: Distance from nearest well --- -------------------_---------- ---------__Distance from nearest building--------- --------------------- --- --- _ ❑ Distance to nearest lot line - �- - `- - - - Remodelin and/or repairing describe) -,-------------------------------- - - "� ` _��Y �----------------------------------------- -------- --------- --------- ----- ----------------- �) C- " 5---------------' - ------- - ------------ -------- -------- -- --- ----------------------------------------------------------- ---------------------------------------------------------------------------------------------------------- -- -- ---- - ---- -------- -- ---- - --------- --------------------------------------- ----------------------------------------------------------------------------------------------------------------------- -- --- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. �r Z -l_ -_ /L C'__, --_Owner and/or Contractor (Signed)- -------- -------- ---- --- -------- `I BY 4 *xc _ - --------- c (;_'V - ---- ---(Title) --- � i_t - (Plot plan, showing size of lot, location o� system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - - - - - DATE_. ---- ---- --------------- ----------------- REVIEWED BY---- ----------------------- - ---- ----------------------- ----- ------------------------------------- DATE------------ --------------------- - - ----------------------- BUILDING PERMIT ISSUED----------------------------------------- - ------------ -------------- --------------------- DATE--------------- -------- -- ------------------------------- Alterations and/or recommendations:__ ------------------------- - --- - --------------------- - - - - --- -------------------- --------------------------------------------------- ----------------- ---------------------------------------- -- ------- ----------- ---- -- ----------------- --------- ---- - -------------------------------------------------------------------------------------------------------- ----- ------------------- ------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------- - ------------------ - ----- - ----- ------- -- -- ------- -------- ---- ------ -------------------------- -------------------------------- -- ---- - ------- ------------- ----- FINAL INSPECTION BY. �:1 - �;-_ 1-_--_ ------ - 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.