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FOR OFFICE USE: { ------------ ----------- APPLICATION FOR SANITATION PERMIT Permit No. .,-;2 1 ------------ ---------------------- ..-� ---------------- --- ----------------- ---------------- (Complete in Duplicate) Date Issued ' ;l .r � ----------------- ------------------------_-------------- This Permit Expires 1 Year From Date Issued 02S _ 1&0 S�[ Application is hereby made to the San Joaquin Local Health District for a permit to construc and install the work herein described. This application is made in compliant ith County Ordinan 549.E ADDRESS OCATIO . ... . JOB N ' """' r� Owner's Name ----- ---- -------------- ----- Phone-------------------------------- ---- ------------------------------- ' f Address.--•---- -- ------- ---------- ------------ - ------- --------------�------------ -----------------•------------------•-•-------- Contractor's Name f •---- Phone.. --------- -------- Installat.ion will serve: Residence Ej-*Apartmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..-)-_ Number of bedrooms �� Number baths .---____ Lofi size __. -7V-40--- ------- •-------- Water Supply: Public system ❑ Community system ❑ Privafe �epth to Water Table ... _- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ff Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date-----------.--------) No ❑ New Construction: Y.es.❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) LR Septic Tank: Distance from nearest well-----------------Distance from foundation------------- Material---------_.__-.-.------.._---------------------. ❑ No. of compartments-------------- ------ ----Size--------------------------------liquid depth---------- ---------------Capacity-.------- 5-� C Dispos Field: Distance from nearest well---15�4.�....Distance from foundation.--...IjPf .. - ---..Distance to nearest lot line................. C Number of lines- __ . jLength of each line...--.I a�Q.------------Width of trench.... r--f_.__.................. -- fo Type of filter material-----------A,___'__Depth of filter material----,/ -------Total length___._Aa-----------------_.-.-.._ !P .;i� �ef 6_11 i Distance to nearest ell._.__ .4.�____Distance from/�foundation ------_-.Distance to nearest lot line.-5__---------ro Number of pits.------ Linin material----s�:./f;_____..SizE: +._._.,-- -_. •� ��.----.Depth -- �---------------------- 7 Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-...........- .-__---. ❑ Size: Diameter-----------------° ------------------.Depth- --------------------------------I-----------------Liquid Capacity----------------------------gals, Privy: Distance from nearest well-------------------------------------------------Distance from nearest building----------------------------------------- F1 Distance to nearest lot line.................. .. 1.— Remodeling and/or repairing (describe)- - I- --1 -- - --------------------•-------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------- ------ ------------------------------------ ------------------------ -------- ---------------------------------------------------11-------------------------------- 11---------------------------.----------------------------------- I hereby cert' at I have prepared this application and that the work will-be-done-in-accordance with San Joaquin County ordinances, State law and rules and r lations of the San Joaquin Local Health District. (Signed)--------- -------- ------------------------ - ------------------------- ----------------------------------------(Owner and/or Contractor) B - -- ---`------------ ------ ------- ------ ------------------------------- -------------(Title)--------- --------------------- ------ ---- -- ---- --------- (Plot plan, showing size of lot, location of stem i relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED-'BY- ._.-.- .- .- -. .. r� - ----------------- = 'DATE-- - .-__-r REVIEWEDBY------------------------------------------------------------------------------------------------------------------------------- DATE---------------------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------- ----------------------- Alterationsand/or recommendations--- ------------------------- --------------------------------------------------------------------------------------------------------------------------------- f --------------- ----------- ----------- ------ ------------------------------------------- -------------•----------------------------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------- -------_------------- ----------•------ -- --------------------- --------------------------------------------------- ------------------------- ---------- ---------- FINAL INSPECTION BY: #''Rr :' Date �� -4�. --------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca, California Tracy,California F.P.ca.