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FOR OFFICE USE: --------------•--------------:------------ APPLICATION FOR SANITATION PERMIT Permit No. ... ,1� ... -- ---------------------------------- ........ (Complete in Duplicate) Date Issued ------------------------ ---- ---------------------------______ This Permit Expires 1 Year From Date Issued A&, - - 005- UUZp 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 D LOCATION - ' 1 Owner's Name------------- - ?--- ------- ---------------------- -------- Y-Phone---------------------- ---------------- Addre - ---- ---------- ---------------------------------------------------------••---------------------..._......---•---- Contractor's Name', - ---------- ---- -- - ------ --------------------- ----------- Phone.--------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other 0 Number of living units: __limber of bedrooms"Number f baths ---/-- Lot size -----j& �'-' ----- a______________�_`4+ Water Supply: Public system ❑_.Community system ❑ Private Depth to Water Table ----- ft. 1 Character of soil to a depth of 3 feet: Sand ❑ Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay Adobe ❑ Hardpan Previous Application Made: (If yes,date....----------------l 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.) y Septic ank: ry Distance from nearest well___ Distance from foundation_____/_0_.--_____-Material----C '��_-__s_ ._.-___..._ + / y v No. of compartments------.`��----------$ize�_�Fr_..11__�Q__/�--��iquid depth-------_-�--�-------_Capacity--- Dispas Field: Distance from nearest well �.t_Distance from foundation____!A?..____".Distance to nearest lot line__ !________ " Number of lines--------- -------------------- Length of each line___.____/o __�._._____.Width of trench_""_�-__ ---------:._ Type of filter material____ 1,k.__.____Depth of filter material----If_--- Total length_____`ql------------------------------ O See/p , Pit: Distance to nearest well_____.100--/Distance from foundation___.fQ._�-------Distance to nearest lot line---- p 9 Size: l}iame#er ---------- Number of Its------- --.------Linin material---_I-_._ ' .�..__.___"_Depth___'0 -------------------- Cesspool: _ F Cesspool: Distance from nearest well_________________Distance from foundation-------------------- material"___--..._____..___.._.____._____,_) ❑ Size: Diameter----- --------------------------------Depth------- ----------- ------------------Liquid Capacity---------------------------S Privy: Distance from nearest well-___________________ --------------___Distance from nearest building---------._"-----------------...__, L ❑ Distance to nearest lot line ------------- -----------------------------------------------------------------------------------"---------------------------•-- f. 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, State law , d rules and regulations the San Joaquin Local Health District. 4a�fionf -------------------- -- -------- - -- --------- - --- (Signed)--------------------- ----------------------- - - - - - - - - - - - )Owner and/or Contractor) •. --- 1--------- - -- ---------------------------------------Title ------------------- ---------_..---------------------------------- By: _ (Plot plan, showing size of lot, location of system in re ls, buildings, etc., can be placed on reverse side). '~" FOR DEPARTMENT USE ONLY + APPLICATION ACCEPTED ----------------------------------------------- DATE---R-~?:7 _ --------------------------- REVIEWEDBY--------------------------------------------- -------------------------------- ---------------------------------------------- DATE------------------- BUILDINGPERMIT ISSUED------------------- --------------------------------------------------------------------------------- DATE------------------------------------------------------------ , Alterations and/or recommendations:------------------ ------ ------------- -- -------------------------------•---------------------------------------------------------------------- ------ --------------------------------------------------- ------------------------------------ --------- -------- ----------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:. ?-a- - �-� Date. --• �� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 724 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.P.co.