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FOR OFFICE USE: - ---------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. 9213 .._.__-a ------.------------ ------ -- (Complete in Duplicate) Date Issued ___ _._ This Permit Expires 7 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. This application is.made i.n.compliance w ith County Ordinance No. 549. ® ._ "—(p_5' s JO ADDRESS AND LOCATION. 14'"j " ' a`,.Ce• --/ 'aa' - ------------------ Owner's Name. ' �"' --- /------------- Phone-----------•-------------- Address-----•----------- --------------------------------------------- -------------------------------- P r 7 Contractor's Name---------------- {- �`�` ------------------------- ----------- Phone--------.....-------------------... Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ly `i Number of living units: _" Number of bedrooms _"`---- Number of,.batik ___�ot size ----------------------------------------------- ------------ Water Supply: Public system ElCommunity system [IPrivate Z-'**Depth to Water Table ______ ft. Character of soil to a depth of 3 feet. Sand ❑ Gravel ❑ Sandy Loam Clay Loam E] Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes ❑ No ❑ FNA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well----- "_r---Distance from foundation----LP__`_____.Material-__-_yr --------------------__________ Q_ ET No. of compartments.._____--P--------------Size--3-- Liquid depth__..____�-------------Capacity__g _�P_ .. -_ Disposa Field: Distance from nearest well___._54*.._Distance from foundation----!_a_1-------Distance to nearest lot line��_ Number of lines--------- ....5_ --_----__Length of each line-----Vim._-----------------W'sdth of trench---- - ----------------------- Type of filter material------__t ............Depth of filter material----1-7_4_-------Total length-----46A---___ ------------------------------ I Seepage Pit: Distance to nearest well----------------------Distance from foundation--------_-----------Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining material---------------------..Size: Diameter-..--------------------Depth--------------------------------- Cesspool: Distance from nearest well----------_------Distance from foundation---_._.___---------Lining material-__...._._.___.._______._________ 0 Size: Diameter--------------------- -------------- De,pth-------------- -------------------------------------Liquid Capacity----------------------------gals. �1 Privy: Distance from nearest well _____ ------------------------------------------Distance from nearest building-----------------------------------_--.-- �a ❑ Distance to nearest lot line---------------------------------- ---t------------------------------------------------------------------------ ----------- -------------- Remodeling (describe): = ;-------•----------------•-------------------•---•-------------------------------- -----------•----•-•-------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------ ---------- - ---------- --------- -------------------------------------------------•-------------------------------------------------------. ---------------------=--------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St laws, and rules and regulations of the San Joaquin Local Health District. , (Signed)----- --------------------- - ----------------- ---------- and/or Contractor) By: -----(Title)-- ---------------- - ---------------- --- - ---- ------ -- (Plot plan, showing size of lot, location of s em in relation to wefts, buildings, etc., can be placed on reverse side). ` FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__,`-0 r0 _<_ - --------------------------------------------------- DATE-." r -------------------------- REVIEWEDBY----------------- --------------------------------1. -- ------ -------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterationsand/or recommendations:-------------------------------------------------------------------------------------------------------------•-------------------------------.-_------- ---------- --------------------------------------------------------------------------------------------------- ----------------------------------•---------------------------------------------------------------------------- ------------------------------------------------------.-------------------------------------------------------------------- ------ --- ----------- -------------------------------------------------------------------------- FINAL INSPECTION BY_____ _______ _ 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