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t FOR OFFICE USE: ------------ ----------------- .__l vl/_c l/ — APPLICATION FOR SANITATION PERMIT Permit No. ------ (Complete in Duplicate) ?/ A�:__ Date I ssued ___. -------------------------------------------------------- This Permit Ex tres 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. llapl-e- JOB ADDRESS AND LOCATION...-, ^1----�/--------------.�--------------------G-----�-------4�� ..--•----------------------••---- Owner's Name-- Gee -------------- ------------ Phone ----------- ------------------------ Address --- ----------Address-_- _ y ....... `;inn.... Contractor's Name...... S. t_ --------__------------•---- -----•- Phone Installation will serve: Residence �J� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ i Number of living units: ________ Number of bedrooms ________ Number of baths ________ Lot size _/-..___� x ......................... I Water Supply: Public system ❑ Community system ❑ Private'W - Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ffl Har �1 Hardpan ❑ Previous Application Made: (if yes, date --- ------------ -----) No [D New Construction: Yes ❑ No ❑ FHA/VA: Yes [1 No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: Y (No septic tank or cesspool permitted if public sewer is available within 200 feet.) F Septic Tank: Distance from nearest well t9 -Distance from founda ion -_I. ..__.Material_------------------ Capacity _�_.�- .._ ® No. of compartments_______ �_________.__ Size____ __ __`J __ ....� Liquid Capacity....................... Disposal Field: Distance from nearest well. ._ Distance from fou Z anion___ - e!�G_—'__.Distance to nearest lot line ... ....... P � Number of lines_________ ________ _ ---------- Length of each li e------------------��-----. Id+h of trench. ---- -_'---.-._-(..--__- Type of filter material -A"' _ _._ Depth of filter material--- L_�.____----- .Total length____.._.��_____..__.. Seepage Pit: Distance to nearest well ____/ i _ `_Distance from fo ndation... 1.Q_'._._._.._.Distance to: nearest lot line.__ Number of pits __:____ �= _--. Lining material_,. _.Size: Dia "Depth ___._____ ............ . Cesspool: Distance from nearest well ------------------ Distance from foundation --- ----- ........... Lining material ............................. ........ ❑ Size: Diameter--- -------------------------------- *Deptk ------- --------------------------------------------Liquid Capacity-------_--•---- .......... gals. Privy: Distance from nearest well '___._._____________________________________Distance from nearest building ----------- .___.------..._.______________- ❑ Distance to nearest lot line -----------•-----------•-------------------- ----------------------------- { Remodeling and/or repairing (describe): ----------- ------------- ---------------------------------------------- .......................... ------------------------------------ ---------•----•---- i--------------------------------------------- t --------------- --------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State. laws, and rules and regulations of the San Joa in Local Health District. {Signed} ------- r ------------------------------------------------------•-- ----,.__.(Owner and/or Contractor) n (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). e ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---- -------------------------------------- DATE------ REVIEWEDBY ------------------------ -----• ----- ----------------------------------------------------------------------------- DATE----------••------------- BUILDINGPERMIT ISSUED ............................ ---------------•--------------------------------------------------------- DATE -------------------------------------------------------------- Alterations and/or recom endations---------------------------------- --- ---_---------------------------••------------ ....-------------------------------------------------------•_...... ----------------------------------------------- -•-- . ) --------------------------------------------------------------------------------------------------------------------------------------------- --------------------- FINAL INSPECTION BY: ... __- ---. - ]] �j rte, --- ----- � Date-----%-�---�---� •`-�---•�-- `-'-- �--------------• •---•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th street Stockton, California Lodi, California Manteca, California Tracy, Californfa ES 9 REVISED 8-99 21A 0-41 Ar LAB