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FOR OFFICE USE: J r 80 f 7 ----- ---I--------`G -----------___------__-- _- _--- ---__ _ APPLICATION FOR SANITATION PERMIT Permit No. ,7;---- ---------------------------- -- - ---------------------------- -- -------- -- J 3l (Complete in Duplicate) + 3� ---•----------•--.�S ---..-------------------------------- -------------- ----- 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 compliance with County Ordinance No. 549, JOB ADDRESS AND LOCATION --- --„Z--- Z �_- .. ....... "r--a-- ---•------------------------------- Owner's Name------- ` ----- Address �� ----------- - ------------------------------------------------- Contractor's Name---------- ... -- - -- _.. . ..._ - - - --r------------------------�------------------------------- ---------------. Phone_y�_�- _.3._�.�.---- Installation will serve: Residence J2'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _f_____ Number of bedrooms _ __.. Number of baths -1--_- Lot size ---L.4_a_/._X___/�S_=_a--- -------------------- Water Supply: Public system 0"" Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date--------- ----------) No ®~ New Construction: Yes ❑ No ka— FHA/VA: Yes ❑ No [9' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Distance from nearest well-----------------Distance from foundation-------------------Material------------------------------------------------- Sepfi� No. of compartments-------------- ----------Size--------------------------------Liquid depth----------------- ---- -- Capacity----------------------- Disposal Field: Distance from nearest well---No--------Distance from foundation---/o----........Distance to nearest lot line.,,4r/-_.-.___ r Number of lines _ --------------- ----Length of each line---------3_l1.__`_----------Width of trench...... Type of filter material___. ,c�c.� _.._Depth of filter material---_/.V._`........Total length_-_---_.3_U------------------------ Seepage Pit: Distance to nearest well----f✓e-----------Distance from foundation---Lf;-_____--- Distance to nearest lot line-5- ----------- [� Number of pits_._._/_____._.__.-_Lining material----ef".� Ak--- _ Size: Diameter._.. Depth_-__2-s'------------------- Cesspool: Distance from nearest well__--------------Distance from foundation-------------------.Lining material.-_____---_._-__-__--___-___-----.._-. ❑ Size: Diameter- ------- - ------ - ------Depth---------------------------------------------------Liquid Capacity------ ---------------------gals. Privy: Distance from neo Distance from nearest building___________________..._.______._________. ❑ Distance to nearest lot line...---___________________ Remodeling and/or repairing (describe)---------------------------------------------------------------------------------------- -= --:--------------•-•-•-------------------------------- ------------------------------------------------------------ •------ •--•-•------------------------------•---•------------ ---------------------- -------- ----------- ---------------------------------------------------- f I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and. regulations of the San oaquin Local Health District. (Signed)--------------- ----------- ___________________ ___ Owner and/or Contractor By:--------------- ------------(Title)------------ ------------------------------------------------ (Plot --- ---------------------- -------- ----------.(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____----d'�--RO( REVIEWED BY-------------------------------- -- --------- ----- ----- -- ------- ----------- --------------------------------------------.- DATE------ ------ -------- --------•-------------- - - BUILDINGPERMIT ISSUED------------- ---------------------------------------------------- --------------- ------ ---------- DATE----------- ---------------------------------------------- -- Alter tion and/or recm ndations:Irya 4115.— � o � - -- -----•----------- ----------- ---------- --- ------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------ ---------------------- .......... ------------------------------------------------------------------ ------------------------------------------------------------------------- ---- --------------------- FINAL INSPECTION BY:- ------- --------------- -- - ------ - Date--- ---------------------------------------- S ------------ ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Er1.