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/ FO OFFICE USE: 1 � � r ------------------------ / , :::� ------------------------------------ APPLICATION'FOR'SANITATION PERMIT Permit No. _._. ... -----"-- _;-- (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. i i JOB ADDRESS AND LOCATI, ....... r�--------- •------------ ---------------------------------------------- ---------- ------------------------------ Phone._-------------------------------- Owner's Name--------------------------- - - -Address------------ --- 6 -------- -------------------••------------ --------------•---------------------------------------- Contractor s Name_ 1 -�------------'-------- ----'------------ ------'---------- --'------'------...------------- Phone------------------------- ...-----.. Installation will serve: Residence [[`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: N ber of bedrooms _�_`3__ Number of baths `____ Lot size ___-7e57)(,_,C2)---7--------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _______ ft. Character of soil to a depth of 3 feet: Sand ElGravel [jSandy Loam ElClay Loam ❑ y ❑ Adobe ardpan ❑ Previous Application Made: {If yes,date---_-_-------.,_.) No W-INew 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 T Distance from-,nearest,.well_____-"i`--.__Distance from foundation__/- --f____.Materia!_ .___. __ P ` =.. —, [ ' ----- A i No. of compartments - --_____.__ ];:";_ _.Ligwd depthYµ!5�1 �....._Y Capacity_ __ � __.__ Disposal Field: Distance from nearest well.- ." .Y -Distance from foundation_____ _._.Distance to nbarest jot line-- ------ _Z_ 1j [ � Number of lines---------�---------------------Length of each line_._._ /-_- --!----Width of trench,.._�_y---------------------- Type of filter materiaL_��_ r1n[?C Depth of filter mate il / _- --._Total length---- --5"(J___-____________________ 00 See pa is Distance to nearest well._.__._�------Distance f 'm"foundation___/-_____________Distance to nearest jot fine -_�l_.-_.._.. Size:-D Depth--t _,5��_-/she------ Number of pits------ __. Linin ma#erial- ___ Cesspool: i Disfance:from nearest well---------_-------Distance from foundation--------------------Lining material_._.__....___.._____.___._--.---_____. ❑ Size: Diameter-- - ----------Depth--------------------- -------- - ------------------Liquid Capacity----------------------------gals. r . Privy: Distance from nearest ell-._.._._--__.__..._____------------------------Distance from nearest building------------------------------ - ___--- E i ❑ Distance:to nearest lot line------------------- --------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe): ` t ----------------••-•----•---------------.... _ - ______ ____-----------------------ti______________._______________ _______.._.__________._._--_____________.._________------ y _ � -- -- ' N 5 __________________________________________________________________________________________________________________________________________ _________________________________________________________________________________ ` I hereby certify that 1 have prepared this application and+lief fhe work will-be done in accordance with San Joaquin County � ordinances, State la a d rule re ulations of the San Joaquin Local Health District. ' ------------------------------------•---_---- -_ -----Owner and/or Contractor) i (Signed)-------------- _ -------i { ------------------------------------------ ) " (Title BY= .. (Plot plan, showing size:o , location of system in #o wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY".- APPLICATION ACCEPTED BY:_�......... --_ ._ __ DAT ------------------_ - REVIEWEDBY----------------------------------------- --------I -------------- ---------- ----- ---------------------------------------- DATE----- --------------------_-------------------------------- BUILDING PERMIT ISSUED-------------- ------------------------------- -------------------------------- --------- DATE------------------------------------------------------------- a ------------------------------------------------------------ ao : -Alterations and/or recommerdsJ -_ ' ✓ ----------------------- ------------------------.---------------------------- -------- -------------------------------------------------- -- ------•------------- -------------------------------------------------------- -- -------------------------------------------------- -•------------------ ------------------ ---------------------- ---------------------------.-------------------------------------------------------------------- -----------------------------------------------'-------------------- -----------------------------------' ------------------'------------------------------- -------------------------- ----- -------------------- ---------------- ------ ----------------------------------'------ ------- ----- ------------ -- - - - --------------------------------------------- ---------------------•-----.-_----------------------------------------------------- Date2 ------ ---=--- --- ------------ s! f FINAL INSPECTION BY:_ -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street , s. a 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California f.R.C o.