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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 21 O ef— It O—f'7 Application is hereby made to the San Joaquin Local Health District for a permit to construct prid install the workerein described. This application is made inc ompliance with County Ordinance No. 549. � r JOB ADDRESS AND LOCATION j/ //A-------- Owner's Name------- -------------------- ......... Phone------------------------------ Address------------- ---•---------------------------------------•------------------------------•-------------------- Contractor's Name_ '1 ---_ = .��r--------------------- Prone...-.... Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --- Number of bedrooms -42-- Number of baths - .-- Lot size ___ a _-- -.-+ --------------- ----------------- Water Supply: Public system ❑ Community system ❑ Private-Depth to Water Table e.%- ft. t 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 gj-'No ❑ FHA/VA: Yes P-i'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: —,,,;,(No-septic tank or cesspool permitted if-public sewer is available within 200 feet.), Tank: Distance from nearest well---: ----- Distan e from foundation-X07. ----.Mate`� _ - ��- ----------- Septic�, No. of compartments--- '-----------------Siz -5��.--------Liquid depth---- .�-----------Capacity-- p------ j Disposal Field: Distance from nearest well.-��_-.-Distance from foundation_e�-t---.Distance to nearest lot line--%J----- �� I Number of lines-__.--_ -_.'._ - Length of each line__1 --- --� Width of trench-, __.--f.__.._-_----.-_-___. 1 Type of filter materialTotal length---` ----- ----- ___ -Depth of filter mater'al_-f ___ ---. Seepage Pit: Distance to 'fr'earest well-----_'__-_------ Distance from foundation------ ---------_.Distance to nearest lot line_---------_-_. ❑ Number of pits----------------------Lining material--------------------..-Size: Diameter------------ - --------Depth---- ------ -------------------- �[ Cesspool: Distance from nearest well-----------------Distance from foundation------------- -----Lining material------------------------------------- El ----.-_-._.---------_----------_--_. ❑ -.. p ------------- Liquid Capacity Size: Diameter_ -----------.- ------- ----- Deth ----------- -- -------- ---------- q P Y --------------------- ..gals. Privy: Distance from nearest well-------------------------------------------.-----Distance from nearest building----.-.__.-----------____----------- --. ❑ Distance to nearest lot line-----,----------- -- ------------------------------------------------------il----------I------ ---------------------------- ------------------ �II Remodeling and/or repairing (describe):--------- `' ' ,l ---- ------------------- -------------------------------------------------------- -- ---------- -- --- - - - - ------------ ------------------------------------------------------•- ---------------------------------------------------------------------------- -------------------------------- ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. \ (Signed)---------------------- '�'` -------- -------------------------- - -----{�.or Contractor BYE------_-----•--------------•---------_--•------------;;:------- --------------- �- ----- e) (Piot plan, showing size of lot, location of system in rel n to wells, buildings, etc., can be placed an reverse side). R FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----F,_R> .J------=------------------------------------------------------------------- DATE.-----J a 5 -------------------- REVIEWEDBY------------------ ------------------- -- - -------------------- ------------------------------------------------------ DATE.----. ----------------------------------- ----------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------------------- - - DATE----------------- ------------------------------------------ Alterations and/or recommendations:------- ----------- --------------- ------------------------------------------------------------------------------------------------------------ ------------------- - ----------------•------------- ----- ------•------------------------------- -------------------•------------------------------------- --------- ------------------------------- -------- l - ----------------------------- - ------------------ -- ------------------ ---- -- --- - --- -------------------- - ------------- ------------------ ------------------- --------------------- - -- ---------- ------------ 6� ,Date . - i ON BFINAL INSPE 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 r F.P.CO.