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FOR OFFICE USE: -- - - ----------------- p APPLICATION FOR SANITATION PERMIT Permit No. . !.. ------- -- ---- ------------------------------------' (Complete in Duplicate) tDate Issued 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 compliaric�e with County Ordinance No. 549. > k �I ; JOB ADDRESS AND CATION- / - &.- - -- -- --- �------------- Owner's Nam ------ - I -- Phone----••------------------- - --- --- -.---- -- -- ----- --------------------- ---- -- --------------------------------------------- ------ ------•-- Address �_ - ---------- --------- --- s t Contractor's Name_ d�.>.�t�- ---- ----------------- ---- Phone.._. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [] Motel ❑ Other ❑ Number of living units: '_,Number of,bedroom.._ Number of aths j_____ Lot size -------- Water Supply: Public system ❑ Community system El Private Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E3 Hardpan Previous Application Made: (If yesidate.....----------------) No ❑ New Construction: 'Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: - .• (No septic tank or cesspool permitted if-public sewer is available within 200 feet.) Septic Tank: Distance from nearest wl Distance from foundation__�. PMateriaf_- _._ ❑ No. of compartments---- ----- ----------- Size-------------------------- -----Liquid depth-------------------------Capacity----------------`--- .. Dispose ield: Distance from nearest well...AV-___Distance from foundation___ __ ..____.Distance to nearest lot line- Number of lines--------- _ - '_ Length of each line_____ __--_______.Width of trench... _ __�� s . : . Type of filter materia ___ _ ------Depth of filter material__ __/_f________.__._Total lencgth_�P_-----_ - 1, ____- Seepa Pit: Distance to nearest well---f�Pr—__Distance from foundation____lp�_.___.Di tante to nearest lot line_��_-_. {'I Number of pits _____-_ __..______Lining-material_-___�.t 1_...5ize: Diameter._.._s ..� --__.Qepth �____-_ i Cesspool: Distance from nearest well-----------------Distance from foundation-----.--------------Lining material__._-___..___..___-___ ❑ Size: Diameter--------------------- -----r..--.Depth------------------------------------------------------Liquid Capacity-- ----------------r-------gals. IPrivy: Distance from nearest well---------------- ---------- --------- ----------Distance from nearest building---------------------_--_-________..-_ ❑ Distance to nearest loft line----- ------------------- - - ----------------•-----------------------------------------------------------------------r---- f } Remodeling and/or repairing (describe)---------- ------ - -----------------•--- -- - - - - ------- 3 '¢ -- ---- f - p` - ' ------ ---------------------------------- ---------r--------------------------------------------------------------------------------------------- -------------------------------------- . 1 herebye'* s. I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sn rules and regulat' ns of the San Joaquin Local Health District. i (Signed)-•------- ------------ --` ------------ -- -- --------- ------ - ------------------------------- - ---_-_----:�-------- er and/or Contractor] By ----- --- ---- ---- - -- ------ -`-- ------ ------- ----"-------------- - (Title)(Plot plan, shf lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). j FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ---J- ------------ ------------------------------------ DATE_..Z.-- , ----------------------------- REVIEWED - --------------------------REVIEWED BY---------------------------------------------------------------------- ----------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED---=------- I------------ ------- ------------------------------------------------------------------- DATE------------------------------------------------------------ Alterations ---- ---Alterations and/or recommendations--------------------------------------- ----- ---- -----------------------=------------------ ---------------------------------------------------------------- -•-------------•----------------------- --=-------------------------------------- -------------------------- -------------------------------------------------------------------------------------------------•--•---------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------- --------- ------------------- - --- -------------------------- ----- -----------------------------•--------------------•---------------------------------------------- t - / r FINAL WSPECTION BY: .lil Date F1_ - ---�� f ------- ------------------------ i SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California t Lodi,California Manteca,California Tracy,California F.P.CC.