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FOR OFFICE USE: - -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. —,2 -- ----------------------------------------------- (Complete in Duplicate) S Date Issued --------------------------------- This Permit Expires I 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. F JOB ADDRESS AND LOCATION__0?.7 _ cc.��___ ,,,• Q-- .-. ------rQ.,.�,t _ Owner's Nam _ -. .sLCJ_(i D-l _ i- '�+- Address-------- -- _ ----�'--X----1 d--�------------------------ Contractor's ------------ - Contractor s Name_- one ---- --- -- ----------------- Ph ----•-------•.................•--- Installation will serve: Residence * Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of Jiving units: _/-_-__ Number of bedrooms _c{-_ Number aths ---t--- Lot size ---- Water Supply: Public system (] Community system El Private Depth to Water Table -------- ft. Character of sail to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam © Clay dobe ❑ Hardpan ❑ Previous Application Made: (if yes,date.-..----- _- .1 No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weld---------------_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----------------- El Number of lines-----------------------------------Length of each line-----__------_- _ _ Width of trench___ -.-.__------_---__-_---------. Type of filter material-------------------------Depth of filter material. @-------..Total length------------------------------------------ t r Distance to nearest well------ _____Distance fr, m found ation----l(}___f........D}stance to nearest lot ❑ Number of pits---.------I-----------Lining materia3------K0..J __.Size: Ddwara*eDepth-----ZS-------------------- Cesspool: Distance from nearest well_---------------Distance from foundation---------.----------Lining material------.----------.-----_--_-.__-_---_. ❑ Size: Diameter--------- -------- -------------------Depth-------------------------------- --- ------------- Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building______-_.__-----_-__---_-.--------------- ❑ Distance to nearest lot line----- ---------------------------.--------- ----------------------------- ---------------------------------------------------------------- Remodeling and/or repairing {describe):---- - --------------------------------------------------- 4i ------------------- ---------------------------------------------------- r7, ---------- -------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San„Joaquin County ordinances, State s, an rules and re ations of the San Joaquin Local Health District. 0------ ---- (Signed)-------- - .�� jG and/or Contractor) gY� -- -- -----------f----- ------------------------------------------------(Title)---------------- --- - --- ---- ---------- --- -- -----=---- (Plot plan, sh size of lot, location of system in r anon to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------ ---------------------------------------------------- DATE---.? - ----_7.`. ----------------------------- REVIEWEDBY--------------------------------------------- --------- --- ------- --------------- ------------------------------------------ DATE----- ----------------------------------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------------------------------------------- DATE Alterations and/or recommendations---------------------------------------------------------------------------------------------------------------------------------------------------•--•---•-- -------.---------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------- --------------------------------- - ----------------------------------------------- - -------- --------------------- ------------------------------------------------------------------- - -------------------------- FINAL INSPECTION BY:. Date-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California /I.