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-,oma--- FOR OFFICE USE: ------------ ------ G Permit No. - � APPLICATION FOR SANITATION PERMIT -------------=------------------------------------------- --------------------- (Complete in Duplicate) Date issued - _..-__ --_ Thlis Permit Expires 1 Year From Date Issue 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. A �.---- ----------------------------------------------------------•----•------- JOB ADDRESS AND LOCATION�-7_...._ ��-=-----W--------------------- Phone i� . face/=f -•----------------• -•------------ -------------------------------------- Phone------------------ --�,5 Owner's Name---------`�---•------------•--- -------------------------------------- Address------------------- __�-.1 --------------I---------------------------••------------ Contractor's Nam Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑. Other ❑ Number of living units: -I----. Number of bedrooms ---I--- Number of baths _/--.. Lot size .....75-A- f-Q-_--------------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table -------- ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan t Previous Application Made:. (if yes,date----- --------------) No E] New Construction: Yes ❑ No E] FHA/VA: Yes ❑ No E] I TYPE: OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.] Septi Tank: Distance from nearest well-.. 0-----Distance from foundation._-0--------- -Material. ltif�- No. of compartments..___,�--------------.- Size---- x --------Liquid depth yf� --------- Capacity---- 7i_- r Disposal Field: Distance from nearest well-..-V......Distance from foundation---!-(I) ......Distance to nearest lot, line.��-------- t Number of lines....--- ---- Length of each line._-..-.- �� r,-------Width of french..... -v-------------- J -� -- Type of filter material_- S}&k---------Depth of filter material------1-5... ...-.-dotal length------- ---=---------------------- ---_..Distance from foundation_.-------.--_-----.Distance to nearest jqf line----------------- ' Seepage Pit: Distance.to;nearest well.............. tf 0 r Number of pits.-- Lining material---------- ------------Size: Diameter----------------------Depth--- C {�-------- Cesspool: Distance from nearest well --------------Distance from foundation--------------------Lining material------------------------------------- ❑ Depth Liquid Capacity-------------------- gals. ; Size: Diameter_ ------------------- I" Privy: Distance from nearest well------------------------------=---- -------------Distance from nearest building------------------------------------------ t D/ ❑ F ------------------------------ Distance to nearest of ine....___.._.-....__..........:.._..___ All - Remodeling and/or repairing (describe ---------------------------------- ------------------------------------------------ --------------------------------------- --- {t s ------------------------ -- •------------------------------------------------------------------- ------- --------- -------------------------------------------------------------•----- ---------------------------------------------------- ------------- --------------- -- ------------------------------------ ---------=-------------------------------------------------------------------------------------------------------------------------- ! hereby certify that ! have prepared this application and that the work will be done in accordance with San Joaquin County ordinance ate laws„and rules apd reg, anon�of the' San Joaquin Local Health District. � ---------- -(Owner and/or Contractor)----------- ------------- --------------------- - - ---�--------------- -------- _ ----- aTitle - -------------- - ----------------------------------------- (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 F - 2- v APPLICATION ACCEPTED BY- DATE------------ ---------- ---------------- = ``=' - - - _[ ----------- ----------------------------------------------------------------- DATE-------- ---------- ---------------------•------------ REVIEWEDBY--------------------------------------------- - - BUILDING PERMIT ISSUED-------- --i------------------------'----------------------------------------- - -------------------- DATE--------- ------- ----------- ----------------------------- Fr ..................................... Alterations and/or recommendations:_-.-.__.-_................ . -----------•----- ---- - t - - ------------------ ------------------------------------------ --------------------------------- --------------------- •-------------- -------.------- _. - - --------- -- --••----------------- --------------- ---------- - ------, �'- Date � > --�_ FINAL INSPECTION BY----------- --------------- -- ---- Cr SAN JOAQUIN LOCAL HEALTH DISTRICT _ 1601 E.Hnrelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California f "