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FOR OFFICE USE: --- ---- --------- .� --------------------------------------------------------- APPLICATION FOR `SANITATION PERMIT Permit No. .�1� -••---- - ------------------ -------------- --------------------- (Complete in Duplicate) $` Date Issued ------------------ This Permit Expires 1 Year From 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. 02�D JOB ADDRESS AND Name �/ LOr CA;TGIO-!N�.___ = i �. •�G;� ----------------------- Owner's --------------------DOwner s Phone-------a--g---- ----`t?-•-2------------1--.-9- . Addres -------s- : -le. _.. -------------------------------------------------------------------------------------------------------------- Contractor's -------------------------Contractor s Name _- i*-v•'. . U ----- Phone--------------------•------------- --c --•--•----------••-- Installation will serve: Residence .0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel El Other [3Number of living units:1....... of bedrooms __�.'_--- Number of baths �_._._ Lot size __� J` ---------------------------------- Water Supply: Public system ❑ Community system ElPrivate.n Depth to Water Table /a-- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam)M Clay ❑ Adobe.0 Hardpan ❑ 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.) Septic Tank: Distance from nearest well4�_--------Distance from foundation_10-------------Material- `_---------------- ___. C No. of compartments---- -------------------Sized 1.1_tr `---- -:---Liquid depth-------�---------------Capacity_1�.q7--- ------ Disposal Field: Distance from nearest well_4-:0.._--_..._Distance from foundation�5�-..__.--__.Distance to nearest lot Iine_�/-_-..____ 11 { 4 Number of lines------3------------------ ------------------Length of each line-__.4&"-----------------Width of trench.fl,�y_ _.--•------------ ----- Type of filter material,/&X------------------Depth of filter material_._1 ---------Total length-_,2-`/-D---------I-_--__________-_____ Seepage Pit: Distance to nearest well_____________ _______Distance from foundation--------------------Distance to nearest lot line----___.____.__ ❑ Number of pits----------------------Lining material-_------------------...Size: Diameter----------------------.Depth---------------------------- ---- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material-------------------.-------._-_-_____ ❑ Size: Diameter--------------------------------------Depth------------------------------------------- --------Liquid Capacity----------------------------gals. Privy: Distance from nearest well"'""'--- -----"-------- nce,jrom!rnearest building----_-------------------------__________- ❑ Distance to nearest lot line=------------ _ = - -------------------------------------------------------------------------- - ---------- ' ---'--------R------i Remodeling and/or repairing (describe]____________________________________ 1 _ :..--------------------I--------'--------------•------------------------`---`--'----------------------------------------- ----------•--•----------------------------------------------- ------ --------I----------- -------1-------- ----`------------^" ----------- ----------------------------------------------- - ------ 6- -- ------------------------------------------- n '�' = -�--------------- ---------------------------------------------------------- ---------- I hereby cer ify that I have prepared this applicatior � that the work will be done[in' accordance with San Joaquin County ordinances, Sta �llaws, and rules ar�d r gulations f the/San Joaquin Local Health Distric,,,_,,,,,,,,j 'A (� -- (Signed)-- _____.----(Owner and/or Contractor) - iI BY---------•---------- - -------------------------- Title (Plot plan, showing size of lot, location of `system in relation to wells, buildings, etc., can be placed on reverse side). r � i ) FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY--- - 2 �--------------- -------------------- ------------------------------- - ----------------------- REVIEWEDBY -- ------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED--------------------------------------------------------------------------------------- - --------- DATE----------------------------- -----------------------•--- --- Alterations and/or recommendations:---------------- - ----------------------------------------------•------------------------------------------------------•-•----------- - ----------------------------------------------------------------------- --- ------------------ - ---------------------------------- -----------•------- FINAL INSPECTION BY:1. F;"'_^ '�`� Date --------- --------------- -------------------------- --- JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California