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FOR OFFICE USE: -- ----------- --------------- --------- --------------------------------------------- ------- ---------_--_-________-_____________._________.-----__. APPLICATION 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 co pliance with County Ordinance No. 549. zorJOB ADDRESS AND LOCATION/� - , ----------�----------> PO_RT-------------��---�.LI�R-.----._CA_R�h��A----.� Owner's Name QR L/ � ----- lei - - Phone.................................... Address171-S ---------•- -n4-- S ...... ............................................................... Contractor's Name----0- 11/1`_R-------------------------------------------------------------------- -------------------------------------------- Phone................................... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ®�$l1MM P, CHP✓t Number of living units: _1___ Number of bedrooms -umber of baths I___ Lot size ____1 _Qrf7. _- �"________________________ Water Supply: Public system ❑ Community system [EKPrivate ❑ Depth to Water Table 1-5--ft. Character of soil to a depth of 3 feet: Sand ®ravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No FHA/VA: Yes ❑ Nom! TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weIL/00___ Distan e from foundation---1 -----____--Material___�pNCR�eT�_-_-___-. [!r"- No. of compartments-----_ -------------Size_ V_X__5__.._..Liquid depth_ Ax,-----------Capacity...rZ_Q'0._- v Disposal Field: Distance from nearest well./0-Q..._Distance from foundation....ZO---------Distance to nearest lot linp.�=.__. Number of lines-------,f------------------------Length of each line------------------------------Width of trench-------2-471--------.---------- 1 Type of filter material---- QC/5--,_Depth of filter material-_ q" _ _ _-� _ __ ___Total length _____90__ _____________________ 40111110 Seepage Pit: Distance to nearest well--------------------Distance from foundation--------------------Distance to nearest lot line----------------- 1-1 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 t -------------------•--•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ A 1 -------------------------------------------------I------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed) = ------ ------------- --- - ------------------- ---------------------------------- -------(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------------j ��- --------------------------------------- DATE-------- -------------------------- --------------------- REVIEWEDBY-------------------------------------------------------- ----------------------------------------------- ------------------ DATE-------------- ----------------------------------- BUILDING PERMIT ISSUED---------------------------------------------------------------------------------------- ------ DATE------------------------------------- Alterations and/or recommendations--------------=----------------- --------------- -------------------•--•------------------•-----•------------••---------•----•-••------------------------------- ---- ----------------------------------------------------------- ------------------------------------------------------------••---•---•-------------------------------------•--•---------- --------------------------------------------------------•-------•---------------- -------------------- --------------------------------------•-----------•---------- ------------------------------------ -----••-------- ----------------- ----------------------- ---•- ------• •------ -----------------•----------- ------------------_-_------------------- --------------------------•---------------------------------------- FINAL INSPECT -----------A--- Date--- -------------------- SAN ------/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.CC.