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FOR OFFICE USE: -- --------------------_-------------_.---.-- APPLICATION FOR SANITATION PERMIT Permit No. .r21-1'�...........`. ----------------------------------------------------- (Complete in Duplicate) This Permit Expires I 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 Ordin nce No. 549. JOB ADDRESS AND LOCATION___ 13 ------- Le Owner's Name---,b -------------------------------------- Phone------------------------------------ Address--- -----------------------------------Address_--•-------- -------------- Contractor's Nam `3�. T--3----- •-----••-- ------- --------------------------------------- Phone----------------------------------- Installation will serve: Residence [fes"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [3 j Number of living units: --f----- Number of bedrooms _z—_ Number of baths __±f_____ Lot size __0_0fro________________ - -- -------•-----•-- Water Supply: Public system 2__&mmunity system [( Private ❑ Depth to Water Table A.__-_ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sa dy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[5-'_H_"ardpan ❑ Previous Application Made: (If yes,date_______ __] No New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi an�C: Distance from nearest well-___.-________Distance from foundation------------------- .Material______.___._____..____.--------------------- No. of compartments------------- - ----- - Size-----•------------------------ Liquid depth--------------- ----Capacity Disposal Field: Distance from nearest well....�.........Distance from foundation—A...............Distance to nearest lot lineJ______ f [ � Number of lines____t-------- Length of each _____.Width of trench_ _ _ _____________________ W Type of filter materialq. -_Depth of filter material_,/ -- Total length___-�___:__)�`----------- Seepage Pit: Distance to nearest well_____-_-__._.______Distence from foundation_,-----------Distance to nearest lot Number of pits---.__f..............Lining materiaL__�°_� ----Size: Diameter__3_3.. ...........Depth...... . -------__.________ Cesspool: Distance from nearest well-----------------Distance from foundation_'----.------------Lining material-------------------------------------- F1 Size: Diameter--------------------------------------Depth----------------------------- --"------------------Liquid Capacity----------------------------gals. Privy: Distance,from nearest well________________________________________________Distance from nearest building---------------------------------- Distance ___..____.__._-____-- ______- Distance to nearest lot line------ ------------------------------------------------------------------------------------------------------ Remodelingand/or repairing (describe)------------------ ------------------------------------------------------------------------------------------------------------------------------------ --------------------------------------------------------------- --------------- r -------------------------------------------------I----- ------------------------------------------------- -1--------------------------------------------------------------------------- --- ____ _ _ I hereby certify that I he prepared this application d that the work will be done in accordance with San Joaquin County ordinances, State laws, and a nd regula ' n f the n Joaquin Local Health District. (Signed)------------ . . ................. - . . . -- ...... --------------------------------------'-----------------------:--------------- ---(Owner and/or Contractor) k is By:-----------------------------------------------------------------------------------------------------------------I----------------(Title)-------------------- - ---- -- -------------- ----------------- (Plot - ------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..___,_.____&- __ --____ --------------------------------- DATE-------- REVIEWED ____..REVIEWED BY------------------------------------ ---------- ----------- ------------------ ------------------------------------------ DATE----------------------------------------------•------------ BUILDING PERMIT ISSUED-------------------!Jxel��.------------------------------------------------------- ----- DATE-------------------------------------------- Alterations and/or recommendations:---------_L_ .�__r`� � -?� .. / ---------------------------------------------------------------------- -----------------------------------------------•---------------------------------------•-----------------------•--------- ---------------------------- ------------------------------------------------------------------------------------------------------------------------------------- ---------------------------- - --------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ---------------------------------- ------------- FINAL INSPECTION $Y:. . -- ------------------------- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California �.P.00.