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FOR OFFICE USE: 7 ------------- ----------------- Permit No. � !-... _ APPLICATION FOR SANITATION PERMIT � - ----------- --------------------------------------------- ---- _-------------- (Complete in Duplicate) Date Issued _--__-- -- i i 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. � 1 ------------------------------------------ JOB ADDRESS AND CATION_'�-'r�-�f[ ' - G''�'' `' " "_ rPhone----••------------------------------ Owner s Name.- �� -- - - --------------------------- - --- - --- --- G-7. ---------4------------------ ------------------------•---------------•-------•---- / Phone •---------------------- Contractor's Name--------------- - ---- -- ------- - Installation will serve: Residence. Apartment House ❑, /Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---._.-- Number of bedrooms y__- Number f baths --/--- Lot size ---Al----- -. Water Supply: Public: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---------------:_.._1 No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ANo septic tank or cesspool permitted;if public sewer is.available within 200.feet.) Septic Tank: Distance from nearest well-----,---------.--Distance from foundation-------------------.Material---------.---------------.-------------.--------- ❑ Capacity ty----------------------- No. of compartments-----. -- Size Liquid depth-------------- Disposal Field: Distance from nearest weld-----------------Distance from foundation---.------_----.--.Distance to nearest lot line----------.-•---- � I p -------Width of trench--------------.---------- El Number of lines-----------------------------------Length of ear . ine__-_-__------------- - � Type of filter material-------------------------Depth of filter material----------------------Total length---.------.-----_----.------___---r----.- tr Seeps Pit: Distance to nearest well------fd_'0.-_ Distance from oundation-- -------._--.Dista�e to nearest lot lute_. -.------_ I Number of pits--'-------- ----------- ining material------ - .}.----.Size: Diameter-- ----�-------- ----Depth---a_---._-------------- 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--------------------------------s----- "f'- _'� w_-- r'..'�"r".�w� -r►.w�.x.r-�"�, -- ------------- -------- -- _�Distance"fo nearest lot Ime-- ' a ' ---------------- -------•---------------------------' Remodeling and/or repairing (descri -- ------------------------ I -------------------------------------------------- ------------------------------------------ ---------------------------------------------------------- y --------------------------------------------------- ----- --- ------ -- - ---------------------------------------------------------------------------------------------------------------------------------------- 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. `, �r and/or Contractor) f (Signed) - ---- -- - ---- ----- ---------- - ----------------- ----------- ------------------ ---- { g ) -------- ---- (T'tl --- ------------ (Plot plan. showing size of lot, location of system i relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY s F APPLICATION ACCEPTED BY ---------------------- DATE _ ------------------- e Y - - -- - -- --------- -- --• -- DATE------------------------------------------------------------- BUILDING PERMIT ISSUED----.-------'- --------- ------------------- -- ------------------------------------------• DATE-------------------------------------- - ------------------- - Alterations and/or recommendations:-------.-.---------------------"9-=------- =--- ------'°-'-----•--- ----------------------------------------------------------------------------------------- --------------------------------------------- - --- i s Date. -------Q � FINAL INSPECTION BY:.... -- - ------------------ ---------------- ------------ -1104 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street Stockton,California Lodi,California Manteca,California Tracy,California