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FOR OFFICE USE: ; ---- / - / � --------------I APPLICATION FOR SANITATION PERMIT Permit No. {Complete in Duplicate) _ --- ----------- This Permit Expires 7 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 Count Ordi nee No.•549. JOB ADDRESS AND LOCATION_-' Qv ,� ------ - --- -- Owner's Name----1 ---- ------------ ' Phone----------- -------------------------------------------------------- - ---- Address-------------- rp, -- Contractor's Name--------- �1--- 3---• ( s---------------- •---•---:-. Phone-------•---------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ___j--- Number of bedrooms _ n umber of baths --_---- Lot f - �V � size ---- Water - -Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- ft.' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Qlay;Loam El Clay ❑ Adobe Er--'Hardpan ❑ Previous Application Made: {if yes,date------------- - -) No D, New Construction; 'Yes„❑ No FHA/VA: Yes ❑ No ®— TYPE OF INSTALLATION AND SPECIFICATIONS: r ” (No septic tank or cesspool permitted if public sewer is available wiffiin 200. feet,) Septic Distance from nearest well-----------------Distance from foundation---------------------- MateriaL -----------------_..-----:-------__..----- 1 No. of compartments ----Size:------- — •- - ------Liquid depth---------------- ---------Capacity Disposal Field: Distance from nearest well-_-�:�--._-.._Distance from foundation---1v___-,?6 --------Distance to''nearest lot line-s -----..- Number of lines---1----------------_-----------Length of each line__ __1--_-_-_:_-----_-Width of�trench---2.,-f:-"--_.--._---- 0 r .- Type of Tilter material-__ oC<. _ Depth of filter material`----------Total length-------lt -/______--__ hl -------------- Seepage Pit: Distance to nearest well-------------- -------Distance from foundation---l4-r -_-----.Distance fo nearest lot line---<�-'-- Number of pits..!---_------ ------Lining material�O_C k----Size: Diameter--------- - _y Deh_-.�. ----------------- 1f1 Cesspool. Distance from nearest well-----------------Distance from foundation.______-------------Lining material---------------------------------- Size: ~___--_ .------- -- Size: Diameter------- ---------- --------r ---------Depth------ ---- -----------------------------------------Liquid Capacity-- ---------------- `------gals. f Privy: Distance from nearest well ---- _Distance from nearest buildin ----- - g------------- ----;------------------ ❑ Distance to nearest lot line------------------------- - -------------- ---- ------------------- --- ------ -------- -------------- -- - Remodeling and/or repairing (describe):--------------------------------- -------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------•--•-----------•------------- --------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sfafe laws, rul s and re la 'ons of the San Joaquin Local Health District, i (Signed)-------------- --- --- -._. --- ----------------------- - --------------- - ----------- -------- -- - ---------------- -- -(Owner and/or Contractor) Y - ------------------------------------------------------------- Title ---------- (plot plan, showing size of lot, location of s stem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------=-------------- - --------------=---------- ------ --------------------------------- DATE----- REVIEWEDBY---- ----------------------------- --------- ---------------------------------------------------------- DATE- BUILDING PERMIT:ISSUED-------- --------------------------------------------- ---------------------------- --------------- DATE-- ------- - - Alt rations and/or recommendations:----------------- --- --- k2 0 -----.----�-----------`------------/r1[lT-----..- �<_-1 - --�---------'------ - r-` -- ` i 4 ------- 17" 101 FINAL INSPECTION BY:. ---------------------------------- Date------------ - 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,CO.