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FOR OFFICE USE, � u APPLICATION FOR SANITATION PERMIT Permit No. -. _ ../....1 ----------------------------------- -------------------- r (Complete in Duplicate) ' --------------------------------------------.___,.- __ This Permit Expires 1 Year From Date Issued 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. JOB ADDRESS AND LOCATION------------------------ f --------- `---- --------------------------- Owner's Name-------------------------- ----------------------- ----•-- ------- ---- ..... ------& K-� S ---------- Phone--- _----- Address ------'------------------------------- ......r --------------- Contractor's >: Name-------------------------------------------------- AIS-14------- - -----AJ r--�-------------------------_------- Phone 5 ----/..q.6.0-7 Installation.will serve: Residence (( Apartment House ❑ Commercial ❑ Trailer Court [❑ Motel ❑] Other ❑ Number of living units: _-_ Number of bedrooms -_ Number of baths _z_—Lot size ------ __________________ Water Supply: Public system Community system ❑ Private E] Depth to Water Table A{__Qft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam X Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) 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 'rank: Distance from nearest well ______________Distance from foundation--------------------Material_..____________-____.--______________-___...___. ❑ No. of compartments-- -----------------------Size------------------ -----• .__Liquid depth--------------- ---------Capacity------ --------------- Field: ell Dis Distance from nearest w0.__.'-- Distance from foundation__�^�_"...__Distance to nearest lot line__ .__ JKNumber l of lines----------------f---- ------- -- Length of each line------- - -1----------Widfh of trench-_--------Z'q- -------------- Type of filfer material----1___—&c •�Qepth of filter material-._._IT-----------Total length_________------------�_4 -------------------- 00 Seepage Pit: Distance to nearest well------- __Distance o fou dation___ A a ______.Dist nce to nearest lot line_________________ Number of pits----------(------- 9 .5 .--- Depth----------- t------- --Lining material_____--_ _._ ¢e: ;3iameter__..__ Cesspool: Distance from nearest well-___________-.__Distance from foundation--------------------Lining material------------------------------------- ❑ `I Capacity gals. — !+� Size: Diameter- -- - - - Depth ------ --- -----------------------------------_Liquid Cap Y-----�-"------ 9 ~' Privy: Distarlkce from nearest well-------------------------------------------------Distance from nearest building_----__----------------------_---.---_--. O ❑ Distance to nearest lot line------------------------- ------ --- ---- - ------------------------ --------------------- -------------------- --------- -10 n � `- P Remodeling and/or repairing (describe:------------ �t �� a____" l_ --------�ys -----•---•--.--------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------- ------ -- ---------- L 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 an lations of the San Joaquin Local Health District. Si ned fl-&-Q1 ------_._�--- ---------- - ---------------- ----------- --------- - ------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). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ --- ------ r----- ------------ DATE----- � REVIEWEDBY--------------------------------------------- ------ DATE----------------------------------------------------------- BUILDING PERMIT ISSUED------------------------------- ------- - ---- ------------------._ DATE--------------------------------------------- --------------- Alterations and/or recommendations:._.___.__. �__._ �-______(1 �'� . . ----- - ------- ------------------------------------------------------------------- ----------------------------------------------------------- --------------------- ----------- ----------------------------- FINAL INSPECTION BY:... _.. -•- � -------- Date -- --�y��/-�S -- --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O. +