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OFOR OFFICE USE: h/, -_- -----------------/ 3 0-.- APPLICATION FOR SANITATION PERMIT Permit No. ._.lrF� _... --------------------- ------------ (Complete in Duplicate) ----------------------------- 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. t v JOB ADDRESS AND L CATION___-3.3f 12 ---I 3 3 2 2— _4 �� -- -- -------------------------------------------------- --------------------- Owner's Name___ ____e. ' #✓ .. - ----- -- �� - Phone--- ------------- ------------------ --------•------. ---•------•-------------------------------------- ------------------------- ------------------------- Address.. Contractor's Name =---------------•--------------- Phone ------------------------ Installation will serve: Residence �Apartment House ❑ . Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of livingunits: __ - Number of bedrooms _. _ Lot size _.._ °_ _. �U -- �- . Number of baths -� ------------------------------•- ---- Water Supply: Public system Ug—Community system ❑ Private ❑ Depth to Water Table Xa ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe [Hardpan ❑ Precious Application Made: (If yes,date.- 1 No ®-- New Construction: Yes ]'No ❑ FHA/VA: Yes ❑ No EJ TYPE OF INSTALLATION AND SPECIFICATIONS:. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) .,. Septic Tank: Distance from nearest well---__." _ _.___Distance from foundation_/�_.._..._____.Material----��t 'P� -----------------------_--_--_------------ 0� No. of compartments------` ----------------Size-_..LS'4_ C__9`__-.---Liquid depth--" -- ---------------Capacity--1� gr&4 Disposal Field: Distance from nearest well_.:._---.-------Distance from foundation-l.A------------Distance to nearest lot line--- Number of lines--_. — � --------------------Length of each line_-- -�G.._-..__.----____---Width of trench. ' -------- ------. _--�..-�-- - Type of filter,material'�/---b_4-�------___Depth of filter material/-_.` ------------Total length------/r'q----------------------------_ W Seepage Pit: Distance to nearest well ...:—.___----_-Distance from foundation--/ ---------------Dist ice to nearest lot line_ Number of pi 00 f ...... �_-----------Lining material-_0-G' _._.Size: Diameter----��---- -._Depth------- ` Cesspool: Distance from nearest well-----------------Distance from foundation---- -----------Lining material --.___-.._---..----_----_--___-__-_ ❑ Size: Diameter--------------------------------------De Depth ------------------------------•---------------Li Liquid Capacity P q ----------------------------gals, Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---------------------------------- ....... N ❑ Distance fo nearest lot line---------------------------------------------- ------------------------- Remodeling ---------------------Remodeling and/or repairing (doicribe):------------------------ .•-------- ------------------------------------------------ V%------------)--------- t - -------------------- --------------------------------- -------------------------------------------•----------------------------------------------------------------------------------------------- -------------------------------------------------------- } ------------•- - ---------------------------------------------------------------------------------------------------------- .... O 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County p ordinances, State laws, and rules an regulations of the San Joaq . Local Health District. (Signed)-------------------- ---- ----a-- --- - -___--- -- _--- (Owner and/or Contractor) By:.- ----- Title ------ ---------------- ---------- -- (Plot - - -------- -- (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_. .�-- Q _ ___--_____. _ REVIEWEDBY------------------------- ------ ------------ -----------------------------------------------------------•-------------------- DATE---------------------- BUILDING PERMIT ISSUED-------------`------------ ------------------------ - DA-TE-,4 ------------- -- Alterations and/or recommendations:=__- Q. -. - 1._____l -_x�a_r _�_=.� ' . --------------------- --------------------------------------------------------- ---------------------------------------------------------------------------------------------------------- -------------------------------------------------------- -------------------------------------------------- ---------- ------------------------------------------------• -I------------------- -------------------------------------------------------- ----------------- --------- --------- ---------------•--------------------- - - I t FINAL INSPECTION BY:._ e__- ------------------------------- -/ - -------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California