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FOR OFFICE USE: ------------------------------------------- ---- APPLICATION FOR SANITATION PERMIT J� Permit No. ------------------------ -------------------------------- -k (Complelfe in Duplicate) This Permit ExpireijYear From Date Issued Date Issued ___1 ----------- ---------- ----------- -- ------ ----------- Application is hereby made to the San Joaquin Local HealtO.D;strict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinant"e No. 549, JOB ADDRESS AND LOCATION--- ----2 Owner's Name----------'--_-- ---------------------------------------- ------------------------ --------------------- -------------- ---------------------- - ------------ ---------------------- ,61 . - Phone Address---- --------------------------- Contractor's Name__________ _ --------------------------------------------- Ph one__3q901.._ Installation will serve: Resicl6nc, A4—-Aparfmenf House ❑ .11'Commercial 0 Trailer Court E] Ili Motel El Other Number of living units: __/_ Number of bedrooms --jwl- Number of baths'-4 Lot size -------474-'X 2 D_______________ Water Supply. Public system eCommunity system El private 0 Depth to Water Table Y& ft. Character of soil to a depth of 3 feet: Sand 0 Gravel E] Sandy Loam D Clay Loam E] Clay [] Adobe gi_�Iarclpan F] Previous Application Made: I If yes,date---- --- ..........) No New Construction: Yes 0 No �HA/VA: Yes Ej No E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 4Sfi�a n k: Distance from nearest wO-----------------Distall nce from foundation____ ___---______-Material.__.-___________-____._______--- No. of compartments------ --------------- i ---Size- ---------------------- ......Liquid depth- Capacity---------------- Distance from nearest well Disfahce from foundation---1-4--1-----Distance to nearest lot line----------------- Number of lines___.:___,-._.-_.. Lengfh of each line-______oZZ- Width of trench........ _�J�_Depthl of filter mafer;al----_14_R_ _"----Total length-------o2 ---------- ---------- Type of filter materia_ I_. ----- ----- ----------------------- Seepage Pit: Distance to nearest well --------DistJ ncem foundation--- Distance to nearest lot line_____---___ Number of pifs-----/-------------Lining material---- Size: Diameter._-.___------ Distance from nearest well- Depth-------- ------------- V11i Cesspool: ----Distance from foundation___________________------------ 0 Y Size: Diameter--------- _. Lining material---------------- ----------------- Privy: ----------------- .......---Depth----------------------- ---------__ --------------------Liquid Capacity --gals. Distance from nearest well_ ----------------------- -_-_---.__---_.._Distance from nearest b0cling---- --------- Distance to nearest lot line_________________________-11 Remodeling and/or repairing (describe)_____________ ______ ___ - ------------------------ ------------------------------------------------------------------------------------------------ ------------------------ ------------------------------------------------------ ------------------- ---------------- ------------------------------ --------------------------------------------------------------------- ------------------------------------------- r------------------------------------------------------------ ----------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------------- ------------- - I hereby certify that I have prepared this application andifhaf the work will be done in accordance with San Joaquin County- ordinances, to laws, and rules and reoulafions of the Sa Joaquin Local Health District. (Signed)---- J ------- ----------------------------- ----(2wne and/or Contractor) By: j 41uw- - ------------------------------------ --——------------------ ------- ......... (Plot plan, showing size of lot, location of system in relation to Wel buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------ ------------------------------------------I DATE----------- REVIEWEDBY------------------------- -------------------------- ----------------------- ------------------------------------------ DATE BUILDING PERMIT ISSUED Alterations and/or recommendations:.______._ 3 ---------------- ....... -- -------------------------------------------------- ------------ ------------------- - ------------------------------------------------------------------------ ------------------------------------------------ --------------------------------------------------------------------------- -------------------------------------------------------I------------------ - ----------- .... -------------- ------------------ --------------- ------------------------ ------------------- ------------------------ -------- --------------- ----------------------------------------- - ------- -------------- -- ------- -------------------- ----------------------- ----------------_---------I----------------------- -------------------- ---------- --- ------ --------------------------------- - ------------- ------11 --------- -------------- --------------- ------------------ ---------------------- ------------------------------- FINAL INSPECTION BY:. -------- -- ------------------------------------------ Date------ ------- ---------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 11 1 124 Sycamore Street 205 West 9th Street Stockton,California F.P.rc], Lodi,CaliforniaManteca,California Tracy,California