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FOR OFFICE USE: --- APPLICATION FOR SANITATION PERMIT Permit No. ----------------------------=-------------------- ------ (Complete in Duplicate) - Date 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 applica#ion ris made in compliance with County Ordinance No. 549. f2�f0- JOB ADDRESS SAND OCATION__- w- s:--------- --------------------------------- Owner's Name ------ -- ---------- ---- Phone—Z-9-46-5 n. , Address - i�• x=--===jj' -'---------- --------------- --------•---•--------------•--•------------- y _ ContractorsName------ - ------c--- ------Z-f� ------ ----------- ---------------------------------------------------------------- Phone------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -_j-___ Number of bedrooms _'Number of baths ___1___ Lot size .-._-3 ei-asst.._____________________.__..__ Water Supply: 1Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ lPrevious 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.) I Septi Tank: Distance from nearest well ---0--___Distance from foundation__.__1_ ______._.Material___. d]�t- -:_�________________________ s No. of compartments �Lr_.�'. _.Liquid depth--.-.1��.__�--------- ----Capacity_•.e.x -- p '_` -- Dispos Field:- ' Distance from nearest well----�r._ -.r.sDistance from foundation __ta__r__.__.Distance to nearest lot line-5___ >. 5-, ( Number of lines------------�- ------------------Length of each line------- ------.------------.-.Width of trench-„.2___._.______._______.___._.._ ' Type of filter material-_-_ p gth_____ S�_2_:_______De Depth of filter material___._/_f'_..-..___.Total len C3____ ________________________ Seeps a Pit: -t`.,Distance _______- Distance to nearest wellfid.____Distfrom—foundation____/_f/-0-- ----Distance to nearest lot line_ _ _.__.._ lu -f - ., Distance f i f� mber of pits--------- ----------Lining material---_- i-1 t----Size: Diameter--..-- --.----.-.Depth_._. - _ ------------.-----.---- Cesspool: Distance from nearest well_________________Distance from£foundati`o'n--- � '------------Lining material -------------- M____.__. (/} ❑ Size: Diameter---- ------ ............... _Depth---- ---------------------------Liquid GapacitY gals. ------------ Priv Distance fr nearest el f linle----_--'.'- -'_ -----_--------------- ' ---Distance from nearest- building___-------------=--------------------.--. i �;:: G ❑ Remodeling and/or repairing describe ”-` '_____________________ " ` „` _____________ ---------------------------------------- .-__-------------------------_'___...._____.___________-.________.____-____.__...- ________________________________________________________________________________________ _______________ ______ -.____.________-___________.__________________..___._. i ti_______________________________________________________________________________________________ ________�______._____ I hereby certify that I have prepared this application and that the work will be ldone in accordance with San Joaquin County 1h ordinances, State ws, and rules and regulations of the San Joaquin Local-Healfli`District. (Signed)----' ------------------ -- -------- ------------------------------ ---------- -------- ------------- ------------------------ nd/or Contractor) (Plot plan, showing size of lot, location of sysfem in r ation to wells, buildings, etc., can be placed on reverse side). E- � .. FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY------ ---- - -- I--------I------------------------- --------------------------------------- DATE------- REVIEWEDBY'-------------------------- - - - ----------------- -------- ------------------------------------------------- DATE----- ] BUILDINGPERMIT ISSUED -- --- --------------------------------------- ----------------------------------------------- DATE--------------------------- Alterations and/or recommendatints:------------------- - ----------••----------- --•----------- - - - --------------------------------------------------�-- I ------------------------------------ -- - - ----------------------------- ------------------------------------------------------------------------------------------------------------ ......... ---------------------------- ----------------- ------------------------------------------------------ - ------ -- --- ------ -------- ------------------- -----------------------------------------------------------------—----------------- ------ FINAL ---------------- FINAL INSPECTION BY--------O4SN --------------------- Date------- c� OAQUIN 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.CO.