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FOROFFICE USE: ---------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. _vzZQ31----- --------------------------------------- ----------------- {Complete in Duplicate} This Permit Ex ires i Year From Date Issued bate Issued . /. ..: .G.. Application is hereby made to the San Joaquin Local Health District for a permit to construct and install thewor ereln described. This Application is made in compliance vjjfh County Ordinance No. 549. c/jf/ l`�13IG ou. t_oCc�T-�-'�.E_.�.D �� / �,� (� �� JOB ADDRESS AND LOCATION_y� y` - Q-f�------------�/• -- 1- ---------- � t. Owner's Name----- '- ''.J...-l-L-. "i-- -------------------------------------------------------------- --- -- ------- Phone------------------------------------ Address_ Contractor's Name-- --QJ--.- 0 T' �._} ---------------------------------------------------------------------------------------- Phone-1,&..er �.J_7___�tf Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: _- ----- Number of bedrooms -------- Number of baths -------- Lot size ------- Water Su y Community system L] Private El _ .-Depth to Water Table .__ . ft. �/o Supply: Public system F] 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 I 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--------------------------------Liquid depth------------------------..Capacity----------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation.-------------------Distance to nearest lot line.-------_-------. ❑ Number of lines-----------------------------------Length of each line-----------------------------.Width of trench----------------------------------- Type ------------- ----_Type of filter material-_-_._.__.._ -----.---.Depth of filter material----------------------- length------------------------------------------ Seepage Pit: Distance to nearest well----------------------Distance from foundation........___._......Distance to nearest lot line----- -------- ❑ Number of pits------------------ ---Lining material----- - -.-----------.Size: Diameter---------_ -----_---Depth------------------------------ -- t Cesspool: Distance from nearest well-----------------Distance from foundation-------.------------Lining material------------------------------------- W . ❑ Size: Diameter- --- --- ---------------Depth------- -------- ----- ----------- ----------.Liquid Capacity------------ - - ---------9als. Privy: Distance from nearest well-------------------------------------------------Di€stance from nearest building------------------------------------ Distance to nearest lot line Remodelin and/or repa'ring describe):_....�'��-___��_�"._ ._- �11�.�. _- � � .: -------- 4-�.�.� �. ash%h ----- ---------------f---�------------------------------ -------- j------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- 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}------------- -- ------------------------------ -------------------------------- ----------------------------------------------------- --.- --(Owner and/or Contractor) By:------------------------------------------------------------------------------------- ---------------------------------------------(Title)------ --- ------ - -------------------------- -- ------ ------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY -------------------------------------------------------------- DATE--- ---------- ---------------------------- REVIEWEDBY------ ---------------------------------- -- ----- ------------------------------------------------------------------- ----- DATE------ -------------•-- BUILDINGPERMIT ISSUED-------------------------------------------------------------------------------------------- --------• DATE------------------------------------- ------ Alterations and/or recommendations------------------------------------------------------------------------------------------------------------------------•------ --------------------------------------------------- --------------------------------------- ------- ------------------------------------------------------------.---------------------------------------------------------- ---•------------------------------------------------- - --- --------------------------------------------------------------------------------------------------- ----------------------------------------------------- -------------------------------- - I--- - ------------------------------------- ----- - --- ------------------------------------------------------------.------------- --- - -------------------------------------- FINAL INSPECTION BY,,e / /, Date =�--G ----------------- ------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street F Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.