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FOR OFFICE USE: ------- -------------- -- ---- --------------------- APPLICATION FOR SANITATION PERMIT Permit No. -------------- --------------------------------- -------- (Complete in Duplicate) G—�a Date Issued ---------------- --.I-.---.I-.- 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. This application is made in compliance with County Ordinance No. 549. 00 �l3~ OY0 51 JOB ADDRESS A--/��_nN�D LOCATION,#Q4--iV -- --- / ' -------- Owner's Name--- ------ -------------------------------------------- ------------- --------------------------------------------- Phone------------------------------------ -------------------- V� " � _ -------------------------------------------------------------------------------------- Contractor's Name--._ - Phone..-...-.----•--•------------•------ Installation will serve: Residence 7Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ _Et Number ofiliving units __I--- Number of bedrooms -P"'- Number of baths --- Lot size ------------------------- Water Supply: Public system ❑ Community system El Private Depth t Water Table - ft. a Character of soil 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 E] No E] FHA/VA: Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (• (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r Septic/Tank: Distance from nearest well----54------Distance from foundation--l-V-----------Material---------------- ------------------------ No. ------------va---No. of compartments-----------Y____------Size-3_f_,�'-_ -!-!'.- --Liquid depth.------- '-�-_-----.Capacity-- -------- Dispos ield: Distance from nearest weal-.-. from foundation-----Aa---------Distance to nearest lot line-:7-1_.__.__-_- Number of lines -------------/-------------------Length of each line------ ---------Width of trench-. - ----------------- - -- Type of filter materiai- St R- .------Depth of filter material....--/ - -...--------Total length----_/-�-d___,--------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line--------------- 0 dumber of pits----------------------Lining material-------------------- -Size: Diameter-----------------------Depth- ------------------------------- Cesspool: -----------------------------Cesspool: Distance from nearest well_---------------Distance from foundation--------------------Lining material-...---------------__-------------- 0 Size: Diameter------------------ -------------------Depth------------- ------- ---------- ------------------Liquid Capacity - _ 9 l --.----__-_----- - ---------------------------Distance from nearest building------------------------------------------ Privy: Distance from nearest well ❑ Distance to nearest lot line------ ------------------------------------------------------ ------------------------------------------------------------------------------- l Remodeling and/or repairing (describe)---------------- -------------------------------------------------------- ------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------- ------- --------------------------------------------------------------------------------------------------------------------------------- ---------------------------------- ---------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stafe laws, and rules and regulations of the San Joaquin Local Health District. (Sign ed �r and/or,Contractor) ------------- - BY� �e ----------------------------------------------_Title)....-.-.----- ------------------ ---------- -- ----- (Plot plan, showing size of lot, locatioqo tem in relation to wells, buildings, etc., can be placed on reverse side). u FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-------- ----------------- ------------------------ DATE----------------------------------------------------------- REVIEWED ----- REVIEWEDBY------------------------------------- ------------------ --------------------------------- DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------- ------ DATE.-------- ---------------------- ---- ---------------------- Alterations and/or recommendations:-------------------- -- ----------------------------------------------- ----------- - -------------- -------------------------------- FINAL INSPECTION BY:. Date-------------------- ---- ---------------- - ----------------_-- ------------- ---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.F.0 0.