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OR OFFICE USE: �3 h Q ------------------------._---------__----�f----------- APPLICATION FOR SANITATION PERMIT Permit No. � fJ�„r3 -- --- ---------------------------------- -------------- (Complete in Duplicate) - -- I This Permit Expires T Year From Date Issued Date Issued _,�?/-Z 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 Coun Ordinance No. 549. JOB ADDRESS AND OCATION/ __ Owner's Name--7.1-- ---- -- - - --------- ------- -------- Phone------------------------------------ Address - -----�---- ^--`- Contractor's Name- ------------------- - -------e---- -- ----�•-- Phone -------- Installation will serve: Residence V4�Apartment House ❑ Commercial C] Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J---- Number of bedrooms -L Number of baths ---_ Lot size Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table 4K,_rft. Character of soil to,a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made: (If yes,date-------------- ----I No ❑ New Construction: Yesj�`No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septi nk: Distance from nearest well-_- m no __1p- --------Material.. -- �- --No. of compartments---o�_-----------------Size----•-,�--Jf�S'JS---`_Liquid depth----Jt'�------------------CapacitY----- � Disposal Field: Distance from nearest well-~--------.-Distance from foundation_/A-f_-------Distance to nearest lot line-- ---..-_- Number of lines------ ---- ------------------Length of each line--%P- Width Width of french----------- -- --' ____-- Type of filter material`f [ ---Depth of filter material--_/e---u_--------Total length----------_� ---'_____________-_ j 1 Seepage Pit: Distance to nearest well----- _Distan p_from foundation---r_3.----_--_-_.Distanceto nearest lot line_._-----_ G Number of pits...'_-�---___------Lining material---./l'--¢ - --Size: Diameter_-------_7 --.---Depth-------- --�5-------------- w Cesspool: Distance from nearest well---------- -----Distance from foundation------------------. Lining material--------__--_---------_------- ❑ Size: Diameter-----'--------------- ------=---------Depth---------------------------------- Liquid Capacity gals. LA Privy: Distance from -nearest well---------------- ----------------- ------..-Distance from nearest building ❑ Distance to nearest lot line- ----------------------------------------------•------------------- Remodeling and/or repairing (describe):---------------------------------------------------------------------------------------- �- -----------------••-------•------------------------------ A-----------=-•------------------------------------------------------------------------------------- --------------•--------------------------------- ---------------------- ------------------ ------------------------ ---------------------------------------------------------------------------------------------------------•----------------------- F --i _ --------------------------------------------------------------------------------------- I hereby certify that I have rr,epared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rul andiregulations of t. n Joaqui Local Health District. ,. (Signed) `----- -----' --- -- -------------(Owner and/or Contractor) l - gY ----------------------(Title)---------- --------------------------------------- --- ---- F--------------- ----------------- ----- - (Plot plan, showing si of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- DATE----- :- iJ'__- `_-- -- --------------------------------------------------------------- --- REVIEWED BY -------------- DATE BUILDING PERMIT ISSUED------------------------ -- --- -- ------ --- - -------------------------------------- DATE----- AI rati ns and/or recommendations:.--_-- _-.--_____ - -�-6 40__ - -------------------------------------------------------------------------------------------- -------- ------------------•-------------------------•--------------------------------------------- -------------------------------------------------- --- ---------------------------- - -------------------------------------------- ----------I------- --------- ----------------------- ------------ -------------------- -------------------------- - --------------------------------------------------------- ------------ --------------------- 411 FINAL INSPECTION BY: -- --- ----- Date-----..19-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelten Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California