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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. -••--- / � - ------------ (Complete in Duplicated Date Issued .---------•---••-- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a pefmit.to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 4 JOB ADDRESS AND LOCATION-------- � -- ---------- -------------- -------------------------------•--------------------------------- ---------- Phone------------------------------------ Owners Name_ -� ,�---------- Address------------------ . _ -�.." - ........,.. 1 ----------------------------------------------- Contractor's -•---------Contractor's Name_____: ___ _ �; ---------- Commercial Trailer Court ❑ Motel ❑ Other ❑ Installation will serve: Residence {� (Apartment House ❑ ❑ Number of living units: -1----- Number of bedrooms _.3___ Number of baths _j----- Lot size _=. Water Supply: Public system � Community system ❑ Private ❑ Depth to Water Table 4-0- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam El Clay ❑ Adobe -`Ia-d an F] Previous Application Made: {If yes,date-------------=------) No [C� New Construction: Yes No El FHA/VA: Yes ❑ No }- TYPE OF INSTALLATION AND SPECIFICATIONS: .. 1 (No septic tank or cesspool permitted if public sewer is avatiable within 204 feet.) ion_ / �__ Mate�ial_ c "7 °- arest well --------Distancfrom foundat Septic Tank: distance from ne ___ - - Ca acitY '" ' s -----Li Liquid de th-----`f---- - No. of compartments---- ~ - a , Disposal Field: Distance from nearest well...-&a_ _Distance from foundation.__ 0-----------Distance to nearest lot line-- ------------ Number of lines-----------2-------3----------Length of each line-.L - -Width"of trench----- -- ------ ----------- • 1-..---Depth of filter material---Jam'_--r-.------.Total length--- -�U---------------- P- a Type of fitter material.___.__Qs__. r i r _ ti 00 Seepage Pit: Distance to nearest well---IV-0--._------Distance from foundation---!4-----------Distance to nearest lot line_. ___.____._ or !r De" th---_AZ�----------------- Number of pits-----, ..-------------Lining material---�oc�C_--5i+e: Diameter_ ----- - p Depth-----------------------------fundation--- ------------- -Lining material__. ----------------- Cesspool: --------- Cess ool: Distance. from nearest well-----------------Dis�otance from fo _Liquid Capacity.-.._-_.______.--__________gals. ' p il. ❑ Size: Diameter---- ---------- •--•----- -•-----. --------- Distance from nearest well----•--_---------- ---------------- Distance from nearest building-'----,•-- -------------- Privy: _, . ------ �.f-� ,-•---�-r ❑ -------------------- -------------- near;Dis a est lot ine > - - ------ ----- --- Remodeling and/or repairing (describe)---------------------- ------- -- ------------------- -- - - -------------------- ----- ----------- ------•---------------------------------- ----------------- ---------------------------------------------- -- I hereby certify that I have prepared this applicafibn and that the work will be done in accordance with San Joaquin County ordinances, State I s, and rules and re ulations of t�Joaquin Local Health District. ---(Ow - ner and/or Contractor) i-----------------�--- -------- --------- --- ---- (Signed) -(Title)----------------------- ----------------- - By:----------- (Plot plan, showing size of lot, location of system in relation to walls, buildings,'etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY-- '--------------------------------- ------- ----------------.. t --- -•--- DATE------- --'-•-=-------------------------------------------- REVIEWED BY--------------------------------------------------------------------------------------------- ------------------- DATE---------= BUILDING PERMIT ISSUED------------- - �-------------- ------- _- Alterations and/or recommendations______ ____ ____ __ "-� *. ------------------------------------------ --------- ------------------------ ----------'----------- ----------- ---------------•--. - --------------- - t ----------- ---------------------- - = Date__.._ - - - - FINAL INSPECTION BY:-- � -----=--- �- --- ----•-�- --- ------ --------- ----•----- ---- � �----�--- ------�--� ----------- •_' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ava `''' 1'x 300 West} iak street. 124 Sycamore Street ' 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Ca. �A