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FOR Or �s -- ------6- -- ---- APPLICATION FOR SANITATION PERMIT Permit No. . ..._ ----------------------------- ---- ---------------------- (Complete in Duplicate) Date Issued -..-.__-..----_ _ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Thi a plication is ada in compliance with County Ordinance No. 549. 'T4 ie• PF-.OXT_ IPLL �y JOB ADDRESS AND OCATION___�fJ ---- ------ .. / --------- -`---------�----------------------------------------------------------- Owner's Name---- c--�--------•-------------- - -- -- --------------------------------------- --- ----- --- - ----- ----------- ---- -. Phone-------- ••-•-----------••-•-------- Address -J` S/ / TT Contrac:tor's Name---------------- -- 7l'�-- ya - - - ---------------------- -- ---- ---------------------------------•-_.-_. Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel [T*`Other ❑ Number of living units: -_ ----- Number of bedrooms -------- Number of baths ----- Lot size ____________________ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table�C3 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Lo-am ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: ;If yes,date- ------------------I No ❑ New Construction: Yes 9?N1 ❑ FNA/VA: Yes ❑ No ❑ 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...._------------------ . Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot Gne.._.............. ❑ Number of lines-----------------------------------Length of each line------------------------------Width of trench-------------f-------------------- !J� Type of filter material-------------------------Depth of filter material----------------------- length--------------- ----------------------•'C Seepage i : Distance to neares well ___._ '_Distanc.e�f}rom f undation_/Q------------Dist/ance�to nearest lot line___-_ ------ Number of pits---t_ ---- g Depth---- ---�'--------- Linin matenal-dj& Diameter.__.(c�...._._ 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--------- ---------------------- ------- - -•------------------------------------------ ---- Remodeling and/or repairing (describe�:10 04 Q ----- -----------•---- ------ --------- --------------------- ------------ --------- ------------ --------------- A - ---- -- -------- ------ --------- ---�--------------------------------------- -------------------------------------- -- - -- - - 1 hereby certify that 1 have prepared this applica nd that the wor will be done in accordance with San Joaquin County ordinances, tate laws, and rules an regulations of t e an Joaquin Local Health District. (Signed)--- ------------ w and/or Contractor) P__BY --------------------------------------- ----0__-�-P_-- .1 1. (Title) -- -- ------. r (Plot plan, showing size of lot, location of system in rel ti o wells, buildings, etc., can be placed on reverse side). .,. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ ------- —----------------------------------------- DATE-------f /---__�/f f�s-- - -- -- - ------ REVIEWED BY------------------------------------------------------- ------------ ------------------------------------------ DATE-------- ---------------- ---------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------- -------------------------------------------------- Df,ITE-------------------------------------------------------------- Alterations and/fir recommendations: - 4? ____ .�_ .--_--. - � __.- j".`_�'� �'� �-- -_L_____ ---------•XYZ—� -- --------- -- --mss � ��-; .�t� -----• ----------- ------ ------------------------------------------------- ---------------------- ------------------ -------------- -------------------------------------------------------------------------------------- FINAL INSPECTION 9� r Date f - - I 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 �t