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FOR OFFICE USE: - -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . -:.L ------ ----- -- -------- -------------------------------- [Complete in Duplicate] - Date Issued __��_�� ------- -- ------- - -------------------- -- sued + -_ This Permit Expires 1 Year From Date Is, Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal4 the work herein described. This application is made in compliance.with County Ordinance No. 549. JOB ADDRESS AND LOCATION--- r� `` ��--- '------------------------------------------------------1........-------------------------------- t 'r'1--------------------------•--------- -•--F+ ---- '�- - -- -�------------ - -- --- --- -- Phone------------------------------------ - AOddress_Name_.__ L ---- . _ _ ---- ------------------------------------------------------------------ L ------------------------------- --------------- Phone------------•----- ------ Contractor's .................Lk'C ?Q_ ________._7S Installation will serve: Residence [ " Apartment House ❑ Commercial e Trailer Court ❑ Motel ❑ Other ❑ 1 Number of living units: ------I- Number of bedrooms -------- Number of baths _______ Lot size ---------___________________________________________________ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Tabie _�Pft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Ciay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If ess,diIte--------------------I No New Construction: Yes No FHA/VA: Yes No PP Y ❑ ❑ � ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) I . Septic ank: Distance from nearest well-----------------Distance from foundation------------------ Material-__--___---__---____--_____________---_____---_. ❑ No. of compartments--------------------------Size------------:-------------- :--Liquid depth----------- ---- -----_Capacity----------------------- Disposal ---------------------- II p g line----------------- El --------------- Dis�al F'el�d:• 1 Number lines ea�es� well-----------------penath of nce reach line-om --. _..Wsdthcofttrenchest lot-I---------------------- Type of filter material-------------------------Depth of filter material-----------------------Total length___-_________________- _ - ----------------- Seepage -it: Distance to nearest well___'__"____Distance from foundation_____ Distance to nearest lot line____:_--__-__ Number of pits--------i-------------Lining material------ Diameter-------- . . ..__..Depth----------- 3_ -- ------ Cesspool: Distance from nearest well__.--------------Distance from foundation--------------------Lining material ___-.._.___________________________ ❑ Size: Diameter----- ----------------Dept h--------------_A_�_'�_ .------- - --------------Liquid Capacity----------------------------gals. -Distance from nearest building Privy: Distance from nearest well------------------------------------------- -- g - ------------------ ❑ Distance to neare;sf lot line------------------ -------------------------- - ------------------------------ --------------------------------------------------------------- j Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------•-------------------------------------------------------- 1 . ----------•----------------------------------------------------- --•---•--------------------------------------------------------------•------------------------------------------------------------------------------ ------------------------------------ -------------------------- -------•------------------------------------------------------------------------------------------------------------------------------------------------- -- f I hereby certify that I have prepared this application,and that the work will be done in accordance with San Joaquin County r-� cl, y t regulations of the San Joaquin Local Health District. // --- (Signed) jj ces St laws'--an----r es an (Owner and/or Contractor) BY: f#------------------------------------------------------------------------- --------(Title)--------------- ------------------------------- -------------- (plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). F)ofbEPARTMENT USE ONLY APPLICATION ACCEPTED BY-----------?-- --- u--- ------------------------------------------------- DATE------ ---- ----------------------- REVIEWEDBY---------------------------------------- - --- ---- - -- - ------ ---------------------------------------------------- DATE------ ------ ---------------------------------------------- BUILDINGPERMIT ISSUED---------------- - - ------------------ -------------------------------------------------------- DATE------------------------------------------------------------ Alterations and/or recommendations------- --------------- --- ---------------------------------------------------•-------------------------------•------- ----------------------- -----------------------------•- ------------------------------------ ---- - - --------- ----------------------------------------------------------------------------------------------------------------•------------------- t ------�,�---------d.��:-------------------------- ---------------------------------------------------------------------------------------------- ----------------------- --------- _ - - , -----------"---------------------------------------------------------------------•------'---------------- ' ------------------------------------ , FINAL INSPECTION BY:-----.-- JG ----- - ------- - - Date JF'_�.2 � -� A JOAQUIN LOCAL HEALTH DISTRICT i 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California t '