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FOR OFFICE USE: `^^ -- ---------------- .�7 APPLICATION FOR SANITATION PERMIT Permit No. (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. JOBADDRESS AND LOCATION----1-123------f,------ ------------------------------------------------------------------•-------------------- ----------------------- - _ --------- ------------------------------------------- Phone_lly#-r�•D -;----- Owner s Name-----/q(1 J�E14.D....-- ----�� ----------------------------- - - &---•----e-------�( i----sr--------------------- Address----------- ---------------------------------------------------------------------- ------------------------------------------- r— ` Contractor's Name----- -------------------------------------------------------- ------------------•------------------------------------ Phone----------------------------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _______ Number of bedrooms -------- Number of baths -------- Lot size ----------------------------____________________--_--- Water Supply: Pubilic system ❑ Community system ❑ Private ❑ Depth to Water Table .------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ 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 well_________________Distance from foundation-------------------Material------------------------------------------------- F1 No. of compartments-------------------------Size----------------------------,...Liquid depth---------------- -------. Capacity----------------------- Disposal Field: Distance from nearest well`_- --.Distance from foundation___./0-------Distance to nearest lot line------- Number of lines-----------------I----------------Length of each line--------- �-- --------.Width of trench-------121V---------------------- Type of filter material____._��t*-___.-Depth of filter material________/_�'-4...Total length--------��O_/--------------------__ 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-------------------------------------------------Distance from nearest building----------------------------------------- 0 Distance to nearest lot line--------- ------------------------------------------------------------ ----------- ---- --------------------------------------------- 9 g \ -- ---------a 5------ ------ Remodeling andor ;e d (des e : ------ _o t-i------ / , _)� } y �- ---------- � / � y ------ lip r ar134,4x-1 `f3 ------------------------------------ ------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta s, and ules and regulatio s of the San .Joaquin Local Health District. Owner and------------------------------------------------------------------ [Signed) ( /or Contractor) By:------------------------------------------------------------------ -----------------------------------------------------------------(Title)--------------- ------ ---------------- --------- ----------- (Plot plan, showing size of loft, location of system in relation to wells, buildings, etc., can be placed on reverse side). F DEPARTMENT USE ONLY ry APPLICATION ACCEPTED BY------------ ---- -- - -------- ------------------------------------ ----------------- DATE------ -- 1� f -------------------------- REVIEWED BY------------------------------------- - ---- - ----- - ------ ----------------------------------------------------- DATE--- ------------------------------------------------_----- BUILDINGPERMIT ISSUED-------------------------------- --------------------------------------------------------------------- DA-TE----------•-------------------------------------------------- Alterations and/or recommendations:--..--..----------------------------------------------------------------------------------------------------------------------•------------------------------- 7�� ------------------•-------------------- ---------------------------------------------------------------------------------------------------------------------------- ----------------- --------•------------------------- FINAL INSPECTION BY:.----- ------------ -------- Date--------- r7 7 fY__-- AQUIN LOCAL HEALTH DISTRICT 1601 E.Nazellon Ara. 300 West Oak Street Al24 Sycamore Street 205 West 91h Street Stockton,California Lodi,California ...I� Manteca,California Tracy,California F.P.CO.