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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ... �_ l ------------------ ----------- ------ ------ (Complete in Duplicate) I........... 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 rdinance No. 549. JOB ADDRESS AND LO ATION--- ------------------ -------- ------------------------------------------------------------------------------------------------------ ------- Owner's Name-__1 --- ------- 1 --------------- ------ ----- ---------------- Phone---------------------_-- -- Address. . ---------------•----------------------------------- ------••-------------------------------•---------------- ---........---- Contractor's Name___ :_. `S ----- T ---�'-------------•-------------•-------------------------•-----------•------------------------------------------------ Phone----------------------------------- Installation will serve: Residence erl Apartment House ❑ Commercial .❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _3- Number of baths _Z___ Lot size _7 :.x v o Water Supply: Public system ['—Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet:- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [❑ Clay ❑ Adobe PaHardpan ❑ Previous Application Made: (If yes,date________________..__} No [ New Construction: Yes ❑ No [e FHA/VA: Yes ❑ No ��` I - 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._.------------.----_____..___..___.____--_-_-• No. of compartments------------- ----------_Size--------------------------------Liquid depth---------------------- ---Capacity---------------------- { e � Number of lines-_'14 est well. from foundation--------------------Distance to clearest lot line----------------- Disposal Field—' Distance from nee ar Length of each line__34? P p --------------------- ,3_-----------------------Width of trench.- Type of filter materiaL7K'.0AA._______,rt)epth of filter material_--�______________Total length------ 1 /� C mor) f k Seepage Pit: Distance to nearest well______________________Distance from foundation_/o___ _-_. Qistance to nearest lot line_.`5 _'`__ r Number of pifs-1-----------------Lining material___1 p(!.A_._..Size. Diameter._.3-3."_.._._.Depth___r _� .........--------- ' 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 --------r- ---------- ------------------------------.-----.--------- - 1-4 Remodeling and/or repairing (describ1e�----------------------------------------------------------------------------------------------------------------------------------------------------------- " i I ------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------I-------------- -------------------------------------------------------------------------------------------•-------------------------------------------------------------------------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State law and rules ?�dfrl qua to s of the San Joaquin Local Health District. Si ned ----CZ -------------------- I __.._(Owrte -and or Confractorl 1 By: ...._..I-----------------t-----------------------------------------------------------------------------------(Title)-------------------- --------- ---- - - - - - - ------ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r � FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----------------_/[� - DATE 1 REVIEWEDBY------------------------------------------------------------------------------------- ------ DATE------- ---------------------------------------- ---- BUILDING PERMIT ISSUED------------- ---------------------•---------- ----------- DA•TE-------------------------------------------------------- --- ..s Alterations and/or recommendations:'--------- ----------------------------------------------•------------------------------------------------------•------------------------------ r t ------------------------------------------------------------------------------------------ ----------------------------------------- -- ----------------------------------------------------------------------•------- til+ -------------------------------------------- -------------------------------------------------------------------------------------•---------------- - ---------------------------------------------------- ------------------------- ------------------------------------------------ --- --- -- ------------------------------ --------------- i--� -- ----------------- - -------------------------- FINAL INSPECTION BY:.- - --------------------------- - -- --- Date -------------------- 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.CO.