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OR OFFICE USE; ----------------- 0 l.-��l� . -�2-� APPLICATION FOR SANITATION PERMIT Permit No. ._:_ -- - - ------ ------ ------------------------------ (Complete in Duplicate) ___________________ This Permit Expires 1 Year From Date Issued Date Issued f _ 3 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. JOB ADDRESS AND LOCATION W------------------------------------------------------------------------------------•------------ Owner's Name. ----------------------------------------- --------------------------------------------------------------- Phone------------------------------------ Addro Contractor's Name________ S Phone................................... i Installation will serve: Residence [i"'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ VIZj Number of living units: -----I�Number of bedrooms umber of baths __J---- Lot size 7 Water Supply: Public system M t(Community system ❑ Private ❑ Depth to Water Table a P ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 4D--Ha rdpa n ❑ Previous Application Made: [If yes,date-----------.........I No [T"' New Construction: Yes ❑ No t!j-'FHA/VA: Yes ❑ No 21— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or,cesspool permitted if public sewer is available within 200 feet.) Septic T nk: Distance from nearest well---`r-------Distance from foundation_A.10--•_... Material-_- No. of compartments___vZ___.__r__..____Size____3_xu `/' ` -- ------Liquid depth---- '�-----------------Capacity-ZoRJA- Disposal Field: Distance from nearest well__- ---------Distance from foundation__//_`-_._._ .Distance to nearest lot Number of lines_________ ----------------------Length of each line---'__s.F-_'____.____.___..Width of trench..___p2�__.e- ____._-_---_-_ - Type of filter materral._ �-G.1r________Depth of filter material... __________Total length__-- LL_`,�� _____-_-_------------- Seepage it: Distance to nearest well.____"_—__._________Distance from foundation-----_Q_--------.Distance to nearest lot line-A.47.�-"____.. Number of pits..._-An___________Lining material___._- Ac__Size: Diameter.__._ 3--------Depth------4,45---------------- Cesspool: -'___._ ._Cesspool: Distance from nearest well_______________Distance from foundation._ -----------------Lining material._______._-_.._-_-__ ❑ Size: Diameter----------------------------------4- ----Depth----------------------------- - - - --------------- -Liquid Capacity-.- ------------ --------Privy: Distan1.ce-from nearest well_________{ _____________________________________Distance from nearest building------------------------------------ ❑ Distance to nearest lot 1ine-------------------- --------------------------------------------------- Remodeling ----------- --------------------------Remodeling and/or repairing (clescribel---- ----- ------------------------------------------------------------------------------------- ----------------------- = -----•-------- -•--------------------•--------------------------------------------------------------------------- -------- ---------------------------------------------------- --------------------------------- 1 --------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 ules and regulations of the San Joaquin Local Health District. 3 � ($igned)----------------------- - ---------------- ---------------------------------- ------------------- -------.(Owner and/or Contractor) By:----------------------------------------- -- - -------------------------------------- - '---------:----------------------- -----(Title)------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). �1 ' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY = i r --------------------------- DATE_ 6 REVIEWED BY ------------------------ ---------------------- -------------------------------------------- DATE-- --------------------- BUILDING PERMIT ISSUED------------ - ---------------- DATE--------------------------- --- --------------------------- - ---- --- ---- -- - Alterations and/or recommendations:-------.y�C�f�z-- j...o- --------------------- --------------------- ------------------------------ --------------------------------------------------------------------------------•--------------------------------------------------------------------------------------- I r ---------------------•----- - ------- ------- - --------------------------- - ------------------------------------------------ -------------------------------------------- ------------ - - -- - - FINAL INSPECTION BY:... ��- -------------------------------------- Date / _: _ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street { Stockton,California Lodi,California Manteca,California Tracy, California F.P.0 n. t.