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FOR OFFICE USE: ___ ______________ -----------------------______________ - -- -------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _.- --._.-- (Complete in Duplicate) ._..____ _._ This Permit Expires 1 Year From Date Issued � Date Issued ------------------ ---------------- --- 06 ?_o0—.ScD Application is hereby made to the San Joaquin Local Health District for a permit to construct and install t work rein described. This application is made impliance..with County Ordinance No. 549, crq S!'V!' r !f° JOB ADDRESS AND LOCATION--------�y'r''--'----______________ ----------t"-------------- Owner's Name---- F------ =f' Phone------- -----------•-----------•--- Address----- y - r --- -- --- -- y ----- ------------------------------------------------ yy t -1 Phone--- Contractor's Name--------- F,--•--- . . Installation will serve: Residence RI Apartment House ❑ Commercial ❑ Tra' urt ❑ Motel ❑ Other ❑ Number of living units: I_____ Number of bedrooms _�2____ Number of baths -------- Lot size ______---___ Water Supply: Public system ❑ Community system ❑ Private N Depth to Water Table _a_d_ ft. F Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ® Clay ❑ Adobe,j Hardpan ❑ Previous Application Made: (If,yes,date----------- :-------) -No,[ . - .New Construction'. Yes pa,-No E]--FHA/-VA:-Yes E] —No-2 't 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_.S 61.----Dista . frorry four elation_.-_ -"_______..Material_.__- : . - 9 � - ---,,-rrte�-- --------------� -Li Liquid de th__.__.-__ Ca acit /�_f__�._..-- No. of compartments------=-- - - -------- Disposal ---- Size = q P. P Y Disposal Field: Distance from nearest weli -._._._Distance from foundation---1&!�-------Distance to nearest lot�ne__ _--___. Number of lines--------------- ----+ ---i--�----Length of each line--------_-_--- -------------_.Width of french-.1q.-Ill------ of filter material_I_�_sn,?i;�*epth of filter material-_ .4'?------------ length___.9- __:_______________________ Seepage Pit: distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line------.---------- ❑ Number of pits----------------------Lining materiai-----------------------Size: Diameter.----------------------Depth-------------------------------. Cesspool: Distance from nearest well----------___----Distance from foundation--------------------Lining material-------------------------------------- ElSize: Diameter- ------------------------- ----------Depth-------------------------- --- ---------------------Liquid Capacity-- -------------------------gals. Distance from nearest building � # Privy: Distance from nearest well. g ❑ Distance to nearest lot line- - -------------------------------------------------------------------------------•----------- ------------------------ -- ------- - 1 it I Remodeling and/or repairing {describe)!---------------- ----------------------------------------------------------- ------------------------------------------------------•----------------- ► -------------------- -------------------------------------------------------------------------------------------------------------------------- ------------------ -------------=-----------------------------------------------•------------------------------------------------------------------------------------------------------------------------- -- --------- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations the San Joaquin Local Health District. f �F _--- ----------------------------- ----)Owner and/or Contractor) (Signed ) ...,.� .... .. . ..� r BY: ------------ --- {Title) plan, showing size of lot, location of syst�m'in relation to-wells, buildings;etc.;canbe-'placed-on'reverse side).- (Plot FOR DEPARTMENT USE ONLY DATE �y ---------- --------------------- APPLICATION ACCEPTED BY -� --- --- -- ------- ----------------- ------------------------------------ �"'------- REVIEWEDBY------------------------------- ----------------------- --------------------- --------------------------------- -- DATE BUILDING PERMIT ISSUED-------------------- -- ------------------------------ DATE Alterationsand/or recommendations:-------------- ----- - -----------------------------------------------------------------------------•--------------------------------------- 4 ----------------•----------------------------------------- ----------------------------------------------------------------------------- .------.- ---------------------------------------------------------------------------------------•--- FINAL INSPECTION BY:�/ � ----------- - - ------ --- Date. -- --------- -- ------------- - ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT # 1641 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9fh Street } Stockton,California Lodi,California Manteca,California Tracy,California a r � ,