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FOR OFFICE USE: 74 _ /113 ---------------------- --------------------- APPLICATION FOR SANITATION PERMIT Permit No. -- -------------------------- --------------- ----------- --------------------- -- ---------------------- -----i (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 co!p pliance with County Ordinance No. 549. D�SI 3 JOBADDRESS A AION----------- -- -- ----- --- - ----- ---------------- --- - -•------ ---�-�- '�-- ----------------------------------------------------- Phone - ------------------ -----------------(-f- --- Owner's Nam _ Phone-- ------- -- ----- Address------•---- -- 1 _ . . -------------�---------•----------------- -------------?--- Contractor's Name----------------- -- -------- a --- - - ----- ---- -- ----_---------------------- - Phone �_"7 _. .. Installation will serve: Resicl hce Apartment House C] Commercial ElTrailer Court [I Motel ❑ Other ❑ Number of living units: j___ Number of bedrooms ,,3___ Number of baths _r-_ Lot size --------- -----. ------------"------ Water Supply: Public systeml ❑ Community system ❑ Private X Depth to Water Table __ __ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 0 Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: If yes,date--------- -. __._._] No New Construction: Yes [ffi No E] FHA/VA: Yes ❑ No�, ,l , TYPE OF-INSTALLATION AND SPECIFICATIONS:; .�. :... ... -,.� (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Jf No. of compartments ic nk: Distance from nearest well__�__��_-_Distance from foundation_,._/ ------.Material--- 4 ____."__________________ ----------------- Sept " _______, ------------Size__ _ Liquid depth----- 7/______.-.___Capacity._ QQ Ef I ------- l Disposal field: Distance from nearest well---- Distance from foundation__._,/ ---___.Distance to nearest lot lineEe _ Number of lines--------- --- ---------- Length of each line__________ �.__-._.Wjdth of trench._______`__�`a _""-"".-01 Q Type of L .�e ,iter material____ epth of filter material length--------Q' TD---_---__-___"__"__-_ �L} Seepage Pit: Distance to nearest well______________________Distance from foundation__-________.._.___.Distance to nearest lot line_".______--______ ❑ Number of pits----------------------Lining material--------- ------------Size: Diameter_--------- - --------Depth----.---------------------------- I Cesspool: Distance iifrom'nearest well---_-------------Distance from foundation------- ----------- Lining material------------------------------------_ ❑ Size. Diameter -------- ----- -----.Depth------ F --- id Capacity--------Liqu -��--A ------gais. Privy: Distancel�from nearest well___._._-._"___________ ___________________".._.-_Distance from nearest building"__._-___-.________.___:_---_--.__."_____- ❑ Distance to nearest lot line- ------------------------------- ------------------------------------------------------------------------------------------ --------- Remodeling Ir Remodeling and/or repairing (describe):-------------------------------------- ----------------------------'--------------- ---------- ---•---------------------------•------------- --------------------------------------------------------------------------------------------- --------- --------------------------- --------il'------------------------------------------------I-------------------------•------------------------------------------------------------------------------------------------- I, ---------------••------------------------------------ -------------------------------------------------------------- 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S to laws, a d rules and regulations of the San Joaquin Local Health District. (Signed) ---- -- - _ ----- ------- -------- caner and/or Contractor), B Y:-- ----------------- ------ -------------------------------- -----------(Title} (Plot plan, showing size of lot, location of sy em relation to wells, buildings, etc., can be placed on reverse side). gi. FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED ---- - ---- ---------------------------------- ---------------------"------------------ DATE--- 1 �p-- REVIEWEDBY------------------- -------------------- --------------------------------------------- ------------------------------ ._ DATE------------------------------------------------- ---------- BUILDINGPERMIT ISSUE -------------------- ------------------------------------------- ----------------------- --------- DATE._ --------------------------------------------------------- Alterations and/or recommea�ndations:---------- ----- - - ------ ---------- -------•-------- --------------------------------•---------•---------------------------------------------.. `----------lf ----------------------------------__-------------------------------------------------- -- ------------------•---------------------------------------•------------._._.__ I ----------------------- ------------------------------------------------------------------------------------------------------------------•--- ----- -----------------••--•--------------------- ------------- IM FINAL INSPECTION Date------------f -/97------------- ------------ ----------------- SAJOAQUIN 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`II.P.CC.