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FOR OFFICE USE: ---------- ------------ -------- -------- APPLICATION FOR SANITATION PERMIT Permit No. ...�..... �. -- ---------------- ----------------------------------- PDuplicate) Com lets in pate Issued Date Issued��__-?':..�< ` -----------------------------------------------...... ... This Permit Expires 1 Year From ' 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 wit Count Ordinance No. S49. , . 40- JOB ADDRESS AN LOCATION _i _ g.- - LP11T _Lt Owner`s Name-----L� �� ,�.f'?til ? ; ---- Phane-- - -- lC ' Address ` -'-Qn\ ,U ---------•-•---•--------- ------------- - -- Contractor's Name 7 1�-��. IU -- - ------ Phone.. Installation will serve: Residence Apartment House E] Commercial ❑ Trailer Court [Motel ❑ Other ❑ Number of living units: .-.-.- Number of bedrooms .)�=Number of baths _.2-n tot size _s--3 CALS-------------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Ifs- Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date... --- ---- -----..) No New Construction: Yes'❑ No [{�'A/VA: Yes ❑ No , TYPE OF INSTALLATION AND SPECIFICATIONS: ! (No septic tank or cesspool permitted if public sewer is available within 200 feei.) Septic Tank: Distance from nearest well_______________Distance from foundation----.--------------Material------------------------------------------------- LJ No. of compartments---------- ---- ---Size--------------------------------Liquid derth---------------- -----.....Capacity---------------- ------ I r Disposal Field: Distance from nearest well �..-..Distance from foundation---1_— .-.._....Distance to nearest lot line-�!m!... Number of iines............. .1----_---.----.Length of each lire-----------4.O.._..-____.Width of trench------------—L.q.L�-------- Type of filter material_ lkk_..G_C. _Depth of filter material------W-1-------Total length...................-4.Q-f-..__.-__._ 7- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line..-------..._..- G ❑ Number of pits----------------------Lining material----------------------.Size: Diameter_--------------------Depth---------------------------..---- A Cesspool: Distance from nearest weli-----------------Distance from foundation....-.------------_Lining material----------------------------- 1 ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals' Privy: Distance from nearest well----------------------------------- -------------Dis#ante from nearest building------------------------------.----------- 1 ❑ Distance to nearest lot lire------------------------------------- --------------------------------------------------------------------------•-------------------- ..I S� Remodeling and/or repairing (describe)--------- ------------------------ -------------•-------•----------------------------------------•-------------------------------•--------------------•--- -----------•----•-••------------------------------------------------------------------------------------------------------------------------------------- -------------- -------------------••------------------------------- ---------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Cf ----------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------- 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 s and regulations of the San Joaquin Local Health District. r 51,Irt- - ---�------------------------- ---------- 4_1_ and or Contractor(Signed-------------------------- --------------- - --- -- '�-•-------- / � By:---------------------- ------ --- ---- --�:-_-- �_ `=-----------------------------------------------------------(Title)------------ -------------..._.. -- ---- --------- (Piot plan, showing size o ot, location of s stem in relation to wells, buildings, eic., can be pli ced'on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- - -.-. i------_.----------------------------------------------------- DATE--- 2— REVIEWED BY-------------------------- ------- ------- - -------------------------------------------------------------------------------- DATE-- - ----- ---- ----- ------------------------------------- BUILDINGPERMIT ISSUED-------- ---------------- ---------- --------------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations:------------ ----------------- ----------------------••------------------------------------•-------------------------------•------------------------------- -------------------------•---- --------------------------------- ----------- -----------------------------------------------------------------------•------------------------------ ---------------------------- -----•----------------------------- -------------•---------------------------------------------- --------- --------------------------------- ------------------------------- ----------- -------------------------------- --------------------------------------------------------------- --- ---- ----------------------------- ------ - ---------------------------------- ---------------------- --------------------------------- FINAL INSPECTION BY:. ,. .. Date_ ��---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California