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FOR OFFICE USE: ------------------------------------------------------- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _.��_..-- ---------- Duplicate)--------- ----------------------------------- (Complete in - bate Issued ---,----------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permif to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549, a JOB ADDRESS AND L0CATION.._1�q.,,1ef" '-1 .. __ Owner's Name * T �..11 _ ---------- - -- --------------------------------------- Address--------------------- --------------------------------------Address--------------------- - =-------13ax----- --------- ----------___-------------------------------------------------------------- --------- Contractor's Name-- ------ ----- � ------------ -- Phone. _ _ - Installation will serve: Residence ®Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-1---- Number of bedrooms ---3- Number of baths _f____ Lot size ___e' -ke !C-e______-_________________ Water Supply: Public system ❑ Community system ❑ Private IX Depth to Water Table 1,0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam P9 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_.------------------I No [g New Construction: Yes ❑ No ® FHA/VA: Yes ❑ No PM 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_---_____.--_-.---------_---_____---______--____- o- of compartments--------------- ----------Size---------------------------- ---Liquid clep�h---------- ---- - --------Capacity---------------------- Disposal Field: Distance from nearest well--_.-Distance from foundation._l0__-___._-Disfance to nearest lin ^' _______.� [� Number of lines_______________ Length of each lire___40---�_.___._-_.Width of trench----- �_________________-_ Type of filter material-_- _-__Cfl4e--Depth of filter material__1jf-��____--_Total length_____/e-O------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------Distance to nearest lot line----------------- El Number of pits---------------------Lining material-----------------------Size: Diameter-----------------------Depth- ------ Cesspool: Distance from nearest weli-----------------Distance from foundation--------------------Lining material-------------------------------------- El Size: Diameter -----------------------------Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------------------------------------------- -Distance from nearest building----------------------------------.____--- ❑ Distance to nearest lot line----------------- -----------------------------------------p---------------------------------------------------------------------- ----- Remodeling and/or repairing (desc be�=Cir f� 62 e--- 1- -- -------------------------------------------------------- ----------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------•------------------------ ------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat and rules and regulations of ,�he San Joaquin Local Health District. (Signed)-------- ------ --------------------------�0/!</- -' ------------------------------- wn and/or Contractor) By:------------- ------- ------•---'��-- -- --------------------------------------------------------------- --------{Title)----------------------------I- ------------ ---- ----- - - (Plot plan, showing size of lot, locatfo system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------------------- ----------------------------------•------------------------------- DATE-------------------------- - - ----------- -------------- -- REVIEWEDBY----------------------------------- -------------- ------------------------------------- ------------------------- DATE---------------------- ---------------------- -•------------ BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------- ------------------ DATE----------------------------------- Alterationsand/or recommendations:------------------------------------- - - ----- ----------•---------------------------------------------------------------------------------------------------- --------------------- -----•------------ ----------•------------------------------------------- -------------------------------------------------------------•-----------------------•--•------------------------------------ ------------------------- ------- — ------ -------------------------------- -------- ------------------------------------------------------------------------- ------------------------------ - ------ ----------- --------- ---------- ---------------- - ----------------------------------------------------- -------------------------------------------- FINAL INSPECTION BY--- --------- ------------------------------------ ------------ Date.- ----- ---- � SAN JOAQUIN LOCAL HEALTH DISTRICT 1501 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.R.C Q.