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FOR OFFICE USE: ----- --- - --- ------------------------ ------------ ------------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. ------------------------- ---- --------- ------------ (Complete in Duplicate) ,G Date Issued _�`1 ------------------------------------------ -------------- This Permit Expires 1 Year From Date Issued I Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. t .. - ,T,k�is application is made in compliance with County Ordinance No. 549. fi :2-2- '7l-iv TTLETI-tf uJ SOD 1 - Q /� rte— �f fe. JOB ADDRESS AND LOCATION-------------- - - ----------- L4 G'"` L-------- _r-- ----�1-`�'�-- `--oLJ Owner's Name------ -- -- -------------- Phone--•--•-------------- --- ------------------------------- - - --------------- ------•-------- Address_ .1...-.- -- ---�- -- -•--------------- =-- ^a t T Contractor's Name------ • -•-- Phone. Installation will serve: Residence WApartrn tg' House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. Number of bedrooms _Number ' baths /_____ Lot size $ - _ . lv Water Supply: Public system ❑ Community system ElPrivate Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan 0-!e- Previous Application Made: (If yes,date--------------------I No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ NJ TYPE OF INSTALLATION AND SPECIFICATIONS: 1 (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well_________________Distance from foundation--------------------Material...________.______.-_______._______..__...______- ❑ No. of compartments--------------------------Size--------------------------------Liquid depth------- ----- -- ---- ----Capacity------ ---------------- Disposa field: Distance from nearest well-cs-o-.-_---_Distance from foundation---l-9_-r--------Distance to nearest lot line____ Number of lines_____________/-.-___.--_ _. Length of each line___XA._'____r_-___.Width of trench___._�_,_._________.___________ Type of filter material-__-__--- I--------Depth of filter material._.----/.-�-.__ _._Total length________�,,�Q__________________________ i Seep e Pit: Distance to nearest well------- _L`L.Q_f-Distance from foundation------11?_!____.Distance to nearest lot line___ ..______.__ Number of pits------/-------------Lining material.......Z.r1Z..----..Size: Diameter__..__ ......Depth----- -__S__--_______.____._ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- n 5ize: Diameter- - --- -------- -- ------- -------Depth--------- -----r------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------ ---- --------------------- ----.----- ❑ 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 Coun+y C ordinances, Sta and rules and re ulations of the San Joaquin Local Health District. Q�j (Signed)------(--- ------ ---A ----------- ----- - - -------- --------------- ----------------------------------- ----------------------- _ r�tnd/or Contractorj v BY: -- --- -- [Ti+le) (Plot plan, showing size of lot, location of system in lation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY �" 44 APPLICATION ACCEPTED ------------------------------------------------- ____ DATE__ _ _____ ____________________________________ REVIEWEDBY-------------------------------- - ------ -------- -------------------------- ---------------------------------------------- DATE-------- ---•------•------------•--- ----------------------- BUILDING PERMIT ISSUED----------------- ------------------------------ --------------------------------------------------._ DATE------------------------------------ - ---------------------- Alterations and/or recommendations:----------- ---•------------------- --------------------------------------------------------- ---------------------------------•-- ---------------- -------------------------------------------------------•------------------ ---I ------------- ----------------------------------------------- ---------------------------------------- ---------------------------------- r� FINAL INSPECTION $YR'''' --------------------- Date- ----J_7�4/4/--------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Huxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California