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FOR OFFICE USE: - -------------------=----------------------- ---- APPLICATION FOR SANITATION PERMIT Permit No.--------------------------------------------------- .`- _T � ------------------------------------- ---------------- (Complete in Duplicate) / / ! -_-.--- t 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 compliancti with County Ordinance No. 549. JOB ADDRESS AND LOC- -'iol4Lc _ � _i --G�---____ r --/�-'-- Owner's Name--- + - ,r -t --- Phone------------------------ -- ---------•--•---•- ---•- ----------------- ---- --------- ----....--- Address � - --'�-- --- -------•---------------------- ------- - ------------------------ - --- Contractor's Name-----1- --------------- — ----- ----- - -------- --- ---`---`y � z's e Q Phone----••---- ..... Installation will serve: Residence jApartment House ❑ Commercial ❑ Trailer ourt ❑ Motel ❑ Other ❑. Number of livin units: �__._ Number of bedrooms :_ Number o, baths __ Lot size .-_-- � ___________________ t Water Supply: Public isystem ❑ Community system ❑ Private Depth to ater Table ------ ft. 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 ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool perm tted-if public-sewer-is available within 200 feet.) Septic nk: Distance from nearest-well. =:° _:`.-Distance•f m"fo— undtaor- a=..........Material_____ __ _ _ ----------------- _ r F -r No. of compartments---------7—--------- / deth-----�-f-----------.Ca acct -./�--A.!�_. _r � . Z_. ...........Distance to nearest lot line_r�'._--_-.---_- F ,� Dis os Field: Distance from nearest well_��a______-Distance from foundation_._ ��._ p - Number of lines------------ _________Length of each line--- ._________.____.Width of trench__ .___ _ - _De Depth of filter material___. o ' i Type of filter material------ai�..�------ p �� o dal length lQ�-----------------------------_� - T ,moi re ,,,.,Distance to nearest well____�.��_.______Distance,from foundation-__-._t�a__._____.Distance to nearest lot ime_._S_---------- ❑ ,,Number of pits.-.-- ---- ----------Lining material---- S.11------ISize: Diameter.2_Y_I.4'f_Depth_---_LST ----_. , Cesspool: Distance from nearest well------t---.--_.--Distance from foundation--------------------Lining material-------------------------------------- J El Size: Diameter-------------------------------------- -------------------------- ----- ----Depth�-----}------�--D-�- - - - -- - __-_Liquid Capacity -- --- �--••gals. Privy: Distance from nearest well--------------------------------- Distance \T from nearest building_----,------------------------ , ❑ Distance to nearest lot line------------------------------------------ -------------------------------- ------------------------------------------------------ Remodeling and/or repairing (descril�e):q-- ------------------------- -------------------------------------�-------------------------------•---•-- ----------------------------- "*�� v= ----------------------------------------------------------- =-------------------------------------------------------------------------------- ----------- •----------•-----•--------------------------------------------r--------------------------------------------- f ------------------------------------------------------ ------ ------------------------------------------------------------=------------------------------------------------------------------------------------- I hereby certify that t have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws,'and rules and i regulations of the San Joaquin Local Health District. -_. and/or Contractor ' (Signed) F - - --Ower ) BY:---------- / --- 4------ -- ----- ------ --------------------------------------(Title}------------------------------------------------------ --------- (Plot plan, showing size'of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY_ r l ✓ ' -------- ---- ---- REVIEWED -REVIEWER BY --------------- ----------------------------------------------------------------------------------- DATE - BUILDINGPERMIT ISSUED------------- --------------------------------------------------------------------------------------- DATE.-------- --------------------------------------------------- Alterations and/or recommendations---------------------------- - -----------------------------------------------•-------•------------------------------------------- ------- r r ----------------------------------------------------------------- ------------------------------- -----------------------------------------------------------------------•----------------------------------------------- ---------------------------------------------------------------- ------------------------------------------- ---------------------------------------------------------------------------------------------------- ---------- -- -------- -------------------------- -----------------------------------—--------------- --------------- - ---------------------- --------------------- ---- -- --------------- R FINAL INSPECTION BY:. 1 �-� �� ------------------- Date l,� %%% I 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