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FOR OFFICE USE: � ---------°cam---- � •�' APPLICATION FOR SANITATION PERMIT Permit No. ------ ---------- ---------------- ---------------- -.� .'� . ----------------------------------- ----------------il------ (Complete in Duplicate) This Permit Expires 1 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 Ordinanc No. 549. ��' JOBADDRESS A D LOC TION----- ------ ------------------------- ----------------- --------- -------- -----------------------•--------------------------..._..----------- Owner's Name- - ------------ --------------------------------------------------------------------••---------------------------•=--------------- ---------------------- Phone------------------------------------ Address-------14 6.3- _(��_��s-`_--------------------------------------•------------------------------••- ------------------------------------------------------------...---------------------•------- Contractor's Name- l� `'J-----'-----= `------ Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __j____ Number of bedrooms __ _ Number of baths _'_-_- Lot size ---------------------------------- Water Supply: Public system grl-c-ommunity system ❑ Private ❑ Depth to Water Table krft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [q_�Iardpan ❑ Previous Application Made: {1f yes,date---------- ) No.[ New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No TYPE OF INSTALLATION:AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic nv. Distance from nearest well---------------Distance from foundation--------------------Material-------------------------------------------_----. No. of compartments Liquid de th---------------------_ -Capacity 1. p q I P -- ---------------f----- Disposal Fi Distance from nearest well.....-----.-_Distanceifrom foundation_----------- Distance to nearest lot line_._-_--__. ❑ Number of lines__________________________________Length of each liner__ -.0-----------------Width of trench-'�4---------------------- Zr,ilC ai �- -- Type of filter matenaL�_______________________Depth of filter matenal__�-�__________-____Total length______ -------------..-___________ p , Seepage Pit Distance to nearest well------------------Distance�fr�m foundation__A?._._...___.Distance to nearest lo' line.--- ------ ---- E Number of pits--_I----------------Lining mate riaL __ _ __�_!-O C'�_--.Size: Diameter.-_----74. .- .....Depth------na__((_------.-- -.-------._ 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----------------------------------..--_.-. ❑ Distance to nearest lot lire------------------------- --- ---- ---------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe)--------------------------------------------------------•-----••----------•---------------------- ------ -------------------------------------------------------•-----•----------------------------• -•---------•---------------------------------------------------------------------------------------------------- I hereby certify that ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, r s and regu do of the an Joaquin Local Health District. r-------=---------- ---- -------------- - ---- --------- ---------------------------- ------------------------ ---------- Owner and/or Contractor (Signed} ( ) �! Title BY ---- ----------- - - (Title)) (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 h � �6 REVIEWEDBY--------------------------------- -------------------------------I-- -- ---------------------- - -------------------------�DATE---------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE--------- --------------------------------------------------- Alterationsand/or recommendations:--------------------------------- --------- -------------------------------------------..------------------------------- -------------- --- - ---------------- !' - -----•------------------------------------- ------------------------------- ------------------ ------------- ---------------------------------------------------------- ---------------------------------------------------- 1 /r Date-------- --------------- FINAL INSPECTION BY:. !� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C 13. r —