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FOR OFFICE USE: ----------------- - -------------------- -- ---------- APPLICATION FOR SANITATION PERMIT Permit No. . �J� =-S ------- --- ----------------- ---------------------- --- (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 application is made in compliance with County Ordinance No. 549. ' O JOB ADDRESS AND ATiON-Sccj-: � � �---�---�--.C�---`--"-'-••-G��`�'�`"•�_��,-�'u!�f-�-�-=�'.s:----- Owner's Name-------�- ----�----------- -•------------- ---•-- ---------------------------------------Phone--•--•----•----....-------- --- --- --- --- --- --- --- - Address '� •------ ------------- " fi .. ! Contractor's Name.------ ----------- ----- ------ ---- Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court [_1Motel ❑ Other ii "e m4 Number of living units: _-..f__ Number of bedrooms _� Number of baths ---l--- Lot size --------------------------------.- Water Supply: Public system ❑ Community system ❑ Private Ell, Depth to Water Table ---- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------- ----------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ v TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r � Septic nk: Distance from nearest well---�?------.Distance from foundation_-- 0--_-------.Material.-.__�. 1 ----- ---------------- No. of compartments----- ------------------Siz - - - ' q P. ---- Capacity -----. V � � �-- ,�-_--,__Liquid de th----�-_.-_ - - --_-Ca acit `��G'11 Dispos Field: Distance from nearest well___------ Distance from foundation----/p-...---_--Distance to nearest lot lines-----_.-----. V Number of lines-----------2'-------- ----------Length of each line----Sa-----------------Width of trench---3- --- -----------------• t..-- epth of filter material------�Q--rt ---Total length -�---------------------- Type of filter material--------�� _ -D - -- See je Pit: Distance to nearest well----- _------Distance from foundation-.--I-P.---..-..Distance to nearest lot line____------.- Number of pits-------- __ ---Lining material----- -442--------Size: Diameter______ ..........Dept h--_a- ..........---------- Cesspool: Distance from nearest well-------------_--Distance from foundation-------------------lining material-----------------------------........ ❑ Size: Diameter---- ---------------- ----------- ----Depth-------------- -------------------- - ------------Liquid Capacity---------------------- ----gals. Privy: Distance from nearest well----__ ------------------------------------------Distance from nearest building------------------------------.---------- . (�(� ❑ Distance to nearest lot line------ - ------------- --- ------------ -------------------------------------------------- ------- ------------ --------�'4'y ` Remodelingand/or repairing (describe):-------------------------------------- ---------------•-------------------------------------------------------- --------------------------------------- --------- --------------------------- -------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin CountI ordinances, Stat ws, and rules and regulations of the San Joaquin Local Health District. (Signed) ------- ------------------------------ ------------------------- ------------------- Pr7 * and/or Contracto By-. � .-... :_ ----------------(rifle)---------- - �~- --.-----_- ---- --- -- -- ---- (Plot plan, showing size of lot, location of s tem in relation to wells,','buildings, etc., -can be placed on reverse side). FOR /DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- �� --------------------------------------- --- DATE--` --x--Z —CL REVIEWEDBY----- - ------------------------- - ------------------------------ ----------- ----------------------------------------- --- DATE-___ ------------------------------------- -- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------ Alterations and/or recommendations------------ -------------------------------- -----------------------------------------------------•-•-------•-------•-----•---- ---------------------- ----------M------------- --------------------------------------------- ........-------------------•------------------------------------------------------- -- ------------------------------------------------------------------------------------------------•---------- ---------------------------------------------------------------------------------------------- --- ---------------------------------------------------•--------------------------------------------------------------------- ------------ ---------------------------------- - - ----------------- --------------------------------------------------- ----------------- ------------- ---- -.1---------------- -------------- FINAL INSPECTION BY:. Date-_. � -------- ---------- ------ -------------•------------ ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxeltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodir California Manteca,California Tracy,California F.P.C C.