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FOR OFFICE USE: -------------- ------------------------------- ---------- APPLICATION FOR SANITATION PERMIT Permit No. - ---- -- -------- --------- ------------------------ -- (Complete in Duplicate) 7 Date Issued ------------------------------------------------------- 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 LOCATI 1 `T''` .= ------- Owner's Name a ------------------- Phone.------------------- Address--• - --------------------------� ----- -- ---------------- ------ .------------...----•-------•------------------------------- Contractor's Name------------- ---------- - Prone----.------------------------------- O---y_�-t-- I j - Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other vip Number of living units: ---I--- Number of bedrooms -- Number of baths ---I--- Lot size ____________ _________ _______.__-- 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 eclay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) 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.) f Septic ank: Distance from nearest well------aP_r.__Distance from foundation____---1-?_�__.--Material--_ �__ ------------------ p e7 ��. X--- iquid depth----- ---------------Capacity--J2o No. of compartments __________Size_ _ DisField: Distance from nearest well-----!:e-- Distance from foundation____1p_ . __�_.__Distance to nearest lot line_�_I_______-_ poP/ Number of lines-------------"?'----------------Length of each line-----W.................Width of trench___.2~'______.___-_-----_____- � Type of filter material-------15'._k-------Depth of filter material__.__/5_`_____._..Total length------/1_0____________________________ Seepage Pit: Distance to nearest well------_---------------Distance from foundation-------------------.Distance to nearest lot line.._____._________ �{ ❑ Number of pits----------------------Lining material----------.-----------.Size: Diameter-----------------------Dept h----------------_---------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining materia!____._-.-____.._____._.___._____-_._ El Size: Diameter--------------------------------------De th--------------------------------------- -----------Liquid Capacity gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.--.__--__.__..-____.___________.__...-._. ❑ Distance to nearest lot line---------------------------------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):--------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------•----------------------------------------------------------------------------------------------------------r--------------------------------- ------------------------------------------------- r ------------------------------------ -----------------------------------------------------------------------------------------•----------------------------------------------------------------------------------------------- c - ---------------------- ------------ --------------- ----------------------------------------•------------------------------------------------------------------------------------------------- ------------------------ -- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, Stat ws, and rules and regulations of the San Joaquin Local Health District. (Signed) ---- ----------------- and/or Contractor) `k D -- ----------- (T+le)---- =' -------------------------------- By: (Plot plan, showing size of lot, location of syst in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.._-- -� -�Y •-: -� ----------------------------------------------- DATE...... -•---6--------------------------------- REVIEWED f- -- -- - --------------------------- REVIEWEDBY--------------------------------------------- ----- --------------- ---------------------------------------------------------- DATE------- -------- ---------- ----------------------------- BUILDINGPERMIT ISSUED--------------------------------------------------------------—-------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations-----------------------------------------------------------------------------------------------------------------•------- -------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---- ------ -------•--I--------------------------------------------------------------- - -I---------------------- --------------------------------------•--------------------------------------------------------------------------- ----------------- ----------------------- --------------------------------------------—1-1---------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------ ------------ ---------------------- - ---- --- - - -- - ------ ------------------------------------------ --------------------------------------------------I------------------ ------ FINAL INSPECTION --- BY: -Zv' --s'�F--*}'a=- -------------- Date._-.-�--� �`� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hoxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.P.CO-