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FOR OFFICE USE: 4 - i _________________-___---.___.__-- .._._.____---------- APPLICATION FOR SANITATION PERMIT Permit No: ... ' -------------- ---- --- ------------------------------ --- (Complete in Duplicate) --- ------------ ------------------------------ This Permit Expires ] 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. W7- 2-18.-ile. JOB ADDRESS AND LOC .......... A--�f Q f OwnersName----�,:r!! - -- -- -- ---- ---------/-•--�----•-------------••------------------------•............� -- ------------- _---... Phone...--------------------------------- Address-------- ------ J-57----------- ----4 : -- a---------- -- ----------------- -------------------------------------- ------------- ••---•----••--------- z Contractor's Name- - -- h-r+•-c�� - --- --- ------ =----- --------- - - - - -- -----------•-•--:�------------------ •---------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/_-_ Number of bedrooms __y Number f baths __/..: Lot size Water Supply: Public,system E] Community system El Private [[Depth to,Water Table __.__._ ft_ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam E❑ Clay ❑ Adobe ❑ Hardpan ❑ "* Previous Application Made: (if yes,date-----------.....----) No ❑ New Construction:' Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: s (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------Material------------------------------------ ------------ .W� ❑ No. of compartments---- ---------------------Size-------------------------------Liquid depth.-------------------------Capacity--------------------- Disposal field: Distance from nearest well__.....s:d_!Distance from foundation......,1._a.-`____.Distance to nearest lot line_.S_----._____ Number of lines-------/-------------------------Length of each line___97--____--_____.___.Width of trench___�._/________._._------____ Type of filter material--------- i�_,..--_Depth of filter material___-.____1-�_".__._Total length------S_7--------------------_------ Seepage Pit: Distance to nearest well____ _______________Distance from foundation--------------------Distance to nearest lot line_--_--________ ❑ Number of pits----------------------Lining material--------------.........Size. Diameter------------------ ----Deptih------------------------:-------- Cesspool: Distance from nearest well________________Distance from foundation material-- �_---_--_-__._____._._---_--__ P ' ❑ Size: Diameter.__i--------- ------- - - ---- -----Depth------------------------------------------- - ------Liquid CapacitY------------•---------------gals. Privy: Distance from nearest well------------- ..........Distance from nearest building.----r'__.__._______._____-__------------ , I ❑ Distance to nearest lot line---------------- ------- -------------------- = Remodeling and/or repairing (describe}:__- ----------------------- ------ ------------------I-------------------------------------------------------------------------------------------------------------------- --------••-•--------------------------------------------------- ----------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances. Stat aw and rules and regulations of the San Joaquin Local Health District. r (Signed)---------- ------------------ and/or Contractor) Y ------ --------------------------- - _ 4 r+Ie ; B : - = { )-------------------------------- - ----- ----------------- {Plot plan, showing size of lot, location of sys+em in elation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - fiat - - DA7E - ---- -- REVIEWEDBY__ ----------------------------------- I-----------------------------------------'1`--------------------------------------- DATE---------------- = BUILDING PERMIT ISSUED ---�--------------------------=---------------------------- - - DAZE Alterations and/or recommendations: -L --------------- ---------------------------------------------------------------------------- •---------• -•-------•------------------------------- -•----------------------- -----•------------------------------=-------------- ------------`--------------------------•--•----------------------------------------•----------------------------------------------------------- ---------------------------------------------- -----------------;�--------------'---------------*----------------------------------------------------------------------------------- --------------------------- i s 1 ----------------------------------- ------------------ — ---------- ---------------------- ----- - ------ -•-------------- --••----- ------- -----•-----------•------•---------------------------------- ----- ---------------- -------- FINAL INSPECTION BY:_.----- -------- Date-07..'.------y SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street y 124 Sycamore Street 205 West 4th Street Stockton,California Lodi, California ManteCar California Tracy,California F.P.EO.