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FOR OFFICE USE: ----------------=-r--------------------------- ----- APPLICATION FOR SANITATION PERMIT Permit No'_ f3_- ----- ------------------- ;__� (Complete in Duplicate) - -------------------------------------------------- ---- - This Permit Expires 1 Year From Date Issued 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. JOB ADDRESS AN LOCATION -" {%? ,� -i-�`"i� ......- ----- - 2Z---------- ,/aav ---------------- ---------- = Owner's Name 'rL `}.?'i►''"----------------------- ---------------- --------------------------- Phone. Add --ress---� ------- -. = --- ----------------- --------- ---------------------- Contractor's Name---- C "'�" 7� --------------------•----------------------------------------......---------•---------- Phone------------....-------•----------• � Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -.___- Number of bedrooms -------- Number of aths -------- Lot size ._... ------------------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _----+- Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam W Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes E] No FHA/VA: Yes E] 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 line----------------- F1 Number of lines-----------------------------------Length of each line----------.------------------.Width of trench....------------.-----------_._.._ Type of filter material--------_---------------Depth of filter material------------...--------Total length-.--------------_-..-..-._--------------- r Seepage Pit: Distance to nearest well--- foundation._f�P_. Distances o nearest lot I- _ine_ __-__ ..- [y� Number of pits-----'---------------Lining material-..__!!4A0-/(Size: Diameter._V_'* _C&VDepth....____/f-------------------- ' Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material------------------------------------- De -.-......----.-----------_.---..._.-. --_ �4Size: Diameter._ -: D.epthLiqui'� Capacity _ gals, --------------------- Privy: Distance from nearest well----�.______--------------------------Distance from nearest building.---------------.-..-.....____--..------- ❑ Distance to nearest lot line...-- -------------------------------------- ---------------------------------------------------------------------- Remodeling and/or repairing (describe):----- --- -- ------------------------------------------------------- --,"--------------- ----------------------------------------------- -------------------------------------------------------------------!� ----------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------- ------ ------------ ---------------- -------------------------------------------------------------------------------------------------------•-----------------------------------------------T------------------------- I ----- -I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, aYrulend re ulations of the an Joaquin Local Health District. Si ned ----------- ---------------- ------------- --- -- ---------------------------- (Owner and/or Contractor) (Signed) ---------------------------•------------------------------------------------------ --------------------------------------------(Title)---------- --------------------------- ......... . ,#(Plot-plan,-showing size-of-lot,location-of:system-in,rreEationTto�w.e[IS,buildings,,.etc.,-can,be,placed,on,reverse R t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY._ `J `�jlLlL - DATE-------------------------------------- - --------------------------- REVIEWEDBY----------------------------- ----------------------------- ------------------------ --------------------------------•--- --- DATE-------- ---------------------- -------------------- ------- BUILDINGPERMIT ISSUED------#-- • - --------------------------------------------•---------------- --- - DATE-------------------------------- --------------------------- ' Alterations and/or recommendations:--------------------------- ---------- ------ -------------------------------------------------------•-------------------------- ---- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------- ---------------------------------------------------------------- --------------------- --------------------------- -------------------------------------- -- - ----- -------------------------- FINAL INSPECTION ----- - ----------- Date-------- --------- -------------- -------1--- --------- i S JOAQUIN LOCAL HEALTH DISTRICT 1401 E.ka:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca, California Tracy,California F.P.CO.