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FOR OFFICE USE: f_ f -------------------------------- -------_----------------- APPLICATION FOR SANITATION PERMIT Permit No. ..� --` ` s __ _ -_ __ (Complete in Duplicate) Date Issued --= -_ 7 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. F This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION -- ------- ------A�- '`r-----------------•--------•-------------- / Owner's Name�L_•------ -.-----��----------------------------------------•-----•----- --------- -------------------------- ------------------ Phone---------- ------------------------- Address--------------- y - -- D� 14-n- --------------------------------------- I �.T /— Phone-------_------------------------- Contractor's Name____��-•.--=---••- _ ./�ryHC=4e__________-V`^-_ ___CSS^-!___ _____________ t----- !�R____..__. /- Installation will serve: ResidenceE] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other i Number of living units: J---- Number of bedrooms 3___ Number of baths 3____ Lot size ._____---------------•---- Water Supply: Public system ❑ 'Community system ❑ Private JE, Depth to Water Ta0e,{70_ ft. Character of soil to a depth of 3 fe6t: Sand [jGravel F1Sandy Loam] Clay Loam E] Clay E] Adobe E] Hardpan, Previous Application Made: {If yes,date___________________) No C1New Construction: Yes ❑ No E] FHA/VA: Yes [INo ❑� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest welt/_4�Vi.______Distance from foundation-_Z :�_-------.Material_..--...____________________.__----__...._____. No. of compartments--- --- --- ---Liquid depth------q-- Capacity_.!_' e Disposal Field: Distance from nearest well.Jf q_!_._----_Distance from foundation__J_4.�----------Distance to nearest lot line__r "i------ i Number of lines----;'---------------------------Length of each line---- .9--------- --------Width of ,--•------------------ Type of filter material/9 ---- -_-__ --Depth of filter material--_/.g- _---.---Total length__ - ---- I Seepage Pit: Distance to nearest well_,-0_'_.__.. *_Distance from foundation_l_v__'"---""___.Distance to nearest lot Une__.j__---_.__._. Number of pits-- ---------------Lining material_AA ------- -Size: Diameter--------- -..........Depth_--s.___-" I Cesspool: Distance from nearest well______________-_Distance from foundation___..__, .__.__.Lining material___...._ gals. ❑ Size: Diameter---------------------------- --------Depth-------------------------------- -------- Liquid Capacity---- ------------ < 1. _-fRia Privy: Distance frominearest Weil-------_------------'-------------------------- DMance_from n jarest building-----..._____._------------------.------ ❑ -------------- ------------ ---------------------------------- Distance to neares} lot line----------------------------- --- --==- --- - I� r Remodeling and/or repairing {describe--- ----------------- ------------------- _--=-----=--------•------------------•------ -------------- I -------------------- ' ------------------------------------------------------------------ ----------------------------------------------------------I---------------------- -------------------- --=-- -------------------------------------------------------------------------------------------------------------------------------------------- I 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 Joaquin Local Health District. --___- -_---.{Owner and/or Contractor) (Signed} ------- --- - ----- -- ---------- --------------------- ---------------------- ---- --------- �----------------- "' -----------------------------------------(Title)------ ------------------------- ----- --- ----- ------ Sy:- (Plot plan, showing size of lot, location of syste - in re ation to wells, buildings, etc., can be placed on reverse side]. :t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY., ---- -------------------------- DATE = -, -� �I REVIEWEDBY----------- - ---- ------ ----- ------- ----------------------------------- ------------------------------------------------ DATE------------------------------- ------- ------------------- BUILDING PERMIT ISSUED----------�------- ----------- ----------- ---------- -------- -------------------- -------------- DATE------------------------------------------------------------ Alterations and/or recommendations---------------------------- - ------------'------'--"--'-----"-- ------------------------------------------------------ i -------------- ----------------••----------------------�,-------------------------------- ----------------------------------------------------- '- FINAL INSPECTION BY: 7 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 3oo West ook Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.