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FOR OFFICE USE: ----- ----=------------------------------------- ------------- ----------- - -- -------------------------- APPLICATION FOR-SANITATION PERMIT Permit No. 2...f .-..Q_.• _____________ _ _ (Complete in Duplicate) ff This Permit Expires I 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. JOB ADDRESS AND LOTION------------- l// �------ ------- ------------- fP ✓ Owner's Name------------ ' �-------- --------- � Gx/�> �'/!3 Phone 4: Address------------ zh/� e -------------------------------------------------------•-•---------------------------••-•---------------- Contractor's Name G � -----------------------•-----------------. Phone--••-----------------....---------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ 'Other ❑ Number of living units: -1----- Number of bedrooms ,7.. Number of baths_ Lot size ----------------- Water Supply: Public system 2--c'mmunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑; Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Jay E] Adobe arcipan ❑ 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 T Distance from nearest well Distance from foundation---I--------Mat fial____ /�---------------- No. of compartments______._Z-_-.�...--Size-- I��YltgXld_Liquid depth-----g_________________Capacity_ ' Disposal Field: Distance from nearest well-"---__._-Distance from foundation---&! -------Distance to nearest lot line------$ t_.__ 0/ Number of lines----__________2_._______ -____ Length of each line------ --- of french-------- _�� , Type of filter material+ _ W-Depth of filter material____/ 9�- --.-.--.Total length---------- �r� de, Seepage i Distance to nearest well____rd ---------Distance from fou/ndation--,�Q_1---__.Dista/ce to nearest lo�e-----$ �._.. ' Number of pits----- material -Size: Diameter.-.,M._....._._-.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-------- -------------------- ---------------------------------------------------------------------------------------------- -------------.--- Remodelin and/or re airing (describe):_-------- --- ----------- --- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ 1 hereby certify that I have prepared thi app ion and that the work will be done in accordance with San Joaquin County ordinances, Stat s, rules and regulat n o h San Joaquin Local Health District. [Signed - --- --- --------------------------------------- ------------ ------- ---(Owner and/or Contractor) I 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----------------- DATE. --------- REVIEWEDBY-------------------------------------------- -------------------- ------------------------------- -------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations:------- -- ------------------------------------ ------------------------------------------------------------.---------------•-------------------------------- I -• ----------I------------------------------- --------------------------- ------------------------------------------------------------------ -------------------- ---------I------------------------------------------------- i ---------- ------------------ ----------------------------------------------------- ------ --------------------------------------------------------------------------------------------- ---------------------------------- ------------------------I-------- ------------------------------------------------------------------ --------- --------------------------------------- ----------------- ------------------------------------------•-------------------------------------------------------------------------- ---------------------- ----------- ------- ----------- --- / / i ��- - f r� FINAL INSPECTION BY:. --- Date �! SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r F.P.C 0. -.,