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FO OFFICE USE: ---------- ----- ------- ----------- APPLICATION FOR SANITATION PERMIT Permit IVo. . _ . 7 � 1' ---- ------../ 'i�� (Complete in Duplicate) Date Issued ---------------------------------------------------------- This Permit Expires_1_Year From Date Issued I 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.E JOB ADDRESS AND LOCATION 14P-q. - ......0-A..12.01.1- -----------------------------------------------------------------------------e Owner's Name----------`, -4 - ---- s-------------------------- �-•------- -------------- --- . ------------- -------------------- Address.. ---------------- ,-^"-•='� ....-•------------------------------------------------------------------------------------------------------------------------------ Contractor's Name---------------- - A----------------- ---------------- Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _A___ Number of bedrooms _---1-Number of baths ---I--- Lot size _474!4------ ------------------_______ e Wafer Supply: Public system �? Community system ❑ Private ❑ Depth to Water Table -------- ft. 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 ❑ No K FHA/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 tnearest well'Vm: -.r. Distance from foundation___._l0._'____..Distance to nearest lot line----r---j--____. j(,c.e;,,,.•. Number of lines-----------I-----------------------Length.of each line__________-3Q------------Width of trench.____..2 Type of filter material----S--_ff�X_Depth of filter material---------I_ff.......Total length___________________---_-----99--------- , Seepage Pit: Distance to nearest well_ .Distance from fo ndation______._-1- '-_.Distance to nearest lot line--.-4�!...... O ' �7� ------Depth--------� Number of pits-_____________-------Lining materiaL_5--__-__._____._. ae: Diameter._-____ ' Cesspool• Distance from nearest well_________________Distance from foundation------------------- Lining material-------__..__..______ _..___.__-_._- —P ❑ Size: Diameter------------------------------------- Depth----------------------------- -------- -------------Liquid Capacity-...-----------------------gals. Privy: Distance from nearest well-------_----------______________________I_L-.._Distance from nearest building------------------------------------------p ❑ Distance to nearest lot line---------------------------- ----- ---- --------•---------------------------------------------------------------------------------------------P Remodeling and/or repairing (describe):----------o+ _A----- T I - --- - ---------------------_----------------- ---------- ---H, --------------------------------------------------------------------------------------------------------------------------- --------------•---------•----------------------------------------------------•----------------- - V) ------- - ------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------•------------------- --- --------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County 0 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. .- -- - ----------- (Signed) '--------------------- - (Owner and/or Contractor) I ----------- By:-------------- ---- - ----------- ------------------ ------------------------- -----(Title)------------------------------------ . .--- ---- (Plot plan, showing size of lot, location o system in relation to wells, buildings, etc., can be placed on reverse side}. 7 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED 8Y- DATE - -�`-=3�`-�---- �l' -------------- - REVIEWEDBY----------------------------------------------------------------- ------------ --------------------------------------------- DATE---------- ----- ----------------------------------------- BUILDING PERMIT ISSUED--------------------- - DATE---------------------------- - --------------- -------------- ---------------- ------------- f I � o, _ --------------I--.---------- ----------------------------------------------------- ---- ----------- Alterations and/or recommendations:__--_ _______________._.__.___— ------------- ------------------- --------------------------- --------------------------------------------------------- ------------------------------------------ ----------------------------------------------------- --------------------------------------------- ------------ ------------------------- ------------------------------------- ------------------------------------•-- --------------- ------- ------------- f -------------------------__.-----------------------------------------..-.__-__-_._.___......-_-_--_._.._._._-__--._____--__.._--__--__.__._.___-._..._______.___.___4_...___---_.-.______...._.__..__--.._..-----.--_____ FINAL INSPECTION ------------------------ Date---------- - ---- - ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street E Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO. 1