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FOR OFFICE USE: --------------------------------------------------------- � --_..- APPLICATION FOR SANITATION PERMIT Permit No. .......... ......... (Complete in Duplicate) 1 Date Issued --..-j-------------------------------------------------- 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. JOB ADDRESS AND LOCATION --�'A - -... - =--•-•'------------•-------- ' zd.j-46 S—2,� t Owner's Name-------- ---- -P —-------------------------------------------------.. Phone------------------------------ Address...............--................................................. --- ... Contractor's Name-------------- -•-•-- --`_•------ -----------------------•------ Phone................................. Installation will serve: Residence 1K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number Number of bedrooms _-.3__ Number of baths ____A__ Lot size -------. 't....__e�-.........._. Water Supply: Public system ❑ Community system ❑ Private Pa Depth to Water Table 1-41t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam JR Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No �3 New Construction-, Yes ❑ No IR FHA/VA: Yes ❑ No [ r r ,_ 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................................................. No. of compartments _Size.. Li uid de th------__ ._-._ .Ca aci Capacity Disposal F- Id: Distance from nearest well--- ..Distance from foundation.......:?:?....Distance to nearest lot line....... S //r Number of lines------------------ ------------Length of each line-------------x1-0-------Width of trench..............3�........... ,1-- rType-of filter material._ _Depth of filter material___ _ '_"___.Total length______________tr—_!5?_______________- i Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------.Distance to nearest lot line................. I ❑ Number of pits----------------------Lining material----------.------------Size: Diameter---------------------- Depth-------------------------------_- Cesspool: Distance from nearest well------------- ---Distance from foundation--------------------Lining material--_____________-_____________________ ❑ ySize: Diam'eter__-.--.- -•------------------Depth------------------•-- -•---•----•-----•---- ------Liquid Capacity...........................gals. Privy: D stance from nearest well_________________________________________ _______Distance from nearest building--------------------.-________.__.._._.._. ❑ Distance to nearest lot line------------•--------------------------------- -------------------------........-••-------------_----------•----- ----------------------- Remodeling and/or repairing (describe):_________1� —fie �.....-------------------------- ------------ . . ...... -•................................•-- -----------------------------------------••--------------------•------------------------------------------------------------------------------------•--------------------------------------------.--------------------------•- ---------------------•----------•-----•--------------------------------------------------------------------------------------------------•-•---..__..............----------------------------------- 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 regulafions of the San Joaquin Local Health District. 1 ned _____.(Owner and/or Contractor f BY: ------------------------------:-.----_--_=_--------------- ------- ---------------------- -----------------(rifle)--------------- •----- - -------------- (Plot plan, showing sire of lot, location of system in relation to wells, buifdin`,gs, etc., can be placed on reverse side). 1 ' FOkPEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------•-- :_ !''�` --t---------------- -----}-------------------- DATE------------- t r-•------- REVIEWED BY------------------------------------- ............i-----------------------------------------------------t-------............. DATE------------------ . BUILDING PERMIT ISSUED--------------••--------•----i----------------------------------------------------- ----------------- DATE----------------------._...------------- Alteration and/ r recommendation ____ _____'---------____-- --- _ .._._----_-• . ---....--__ - . --- ---------- ---------------1� --- --------------------------- - ' _ . ---------- --------------- -- -------- . ... FINAL INSPECTION BY-------------------- ------------._:_ Date-------------------------- ,. - ate . . . - 3 SAN JOAQUIN LOCAL HEALTH DISTRICT 130 5oufh American Street 300 West Oak Street 124 Sycamore Street 305 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 6-99 2M 3-61 ATLAS