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FOR OFFICE USE: --------------------- -------- -- APPLICATION FOR SANITATION PERMIT Permit No. .._ J . 3`� -----------------------------------1 --- -- (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. A JOB ADDRESS ANDATION___ .I _a____ __ __ __ __ _ ___ Owner's Name = �G ----- Phone-----------------------•--------•- - - -- ----- ----------------------------- Address------f,•- _...._ --•-•t - ---------• ------- -- ---•-'-•�----•------ - ---- -•----------------------•----------------. ----• ----•------ ------ --- - ---------- Contractor's Name <... . T --°--- ----------------- ----- ----------'" -------------------------- --- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Traiillerr Court ❑ Motel ❑ Other ❑ Number of living units: ---l--- Number of bedrooms_._ Num��Depfh baths _0__ Lot size -----_---------____-------__________________________________ Water Supply: Public system ❑ Community system ❑ Private to Wafter Table -------- ft, Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam �ay 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 permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation-------------------.Material_______.________._.________._________...__.__. k ❑ No. of compartments--------------------------Size----------------------------•---Liquid depth--------------------- - --Capacity------------------- - Disposa field: Distance from nearest well_�C -------Distance from foundation----1.4�-------- Distance to nearest lot line_.5 ____--. Number of lines------------- _- Length of each line------- _.-------_--.Width of french._'Z-_/_._/___________._... it Type of filter material____._ `� -------Depth of filter matenal--------- ...__Total length____.__�.----------------------------- g i Distance to nearest well-------I—PA'r__Distance from foundation-----IQ_/---,Distance to nearest lot line_..5___.__.__ ----Linin material_--S� ------Size: 4�e#e�_ ./1. 2---Depth_...L-'.4�--.__..._ . Number of pits--------/__- g - ----__._-- 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---�-----�-------------- ------------------- ---•--------------------- -------------- ------- ---------- ---------------------- ---------- 11� --- -- ------------------------------------------------------- Remodeling and/or repairing describe):----- __,_Ie--- .[� ------------------------------------- -------------------------------------------------------- --------------------------------------------------------------------------------------•--------- --------------- --I---------- I hereby certify tha ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, nd ules and regulations of the San Joaquin Local Health District. --- ----- r and/or Contractor (Signed) -- ---- --------- -- ------ - ----- - / ) By:--------------- ----- -----.----- -------------- ----------------------------------------------- (Plot -------------------------------------(Title `• ' (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED SY____ __ ._ -___ DATE--_' _� _`__ - - - - - ------------------------------------------- Z ----------------------- ------- REVIEWEDBY------ -------------------------------------- -------------------------------------------------------------------------------- DATE----------------------- ------------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------—-------------------------------------. DATE--------------------------------------------------- --------- Alterations and/or recommendations:----------------------------------------------- -------------------------------------------------------------------------------------------------------------- ----------------------------------------------------•---------------------------------- --------- ------ ------------------------------------ ----------------•----------------------------------------------------- -------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------ FINAL INSPECTION BY: "' ...- Date-- s1.- 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 F.F.Cfl.