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FOR,OFFICE USE: ^f3~� ---------- - APPLICATION FOR SANITATION PERMIT//,7/7/ Permit No. ----- -- -------------------- ---------- ----- -- (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issue 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 LOCATION_____ _____ ___ --- - -- ----------------- --------------- Owner's - m ------- ---- --------- _ _ Address - � ----- -- :::�------- A Contractor's Name------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court E] Motel [I Other [3 i / Number of baths /3-Lot size _1406.`_X-. -r------- •---------•- Number of living units: _f--- Number of bedrooms Water Supply: Public system ❑ Community system ❑ Private [ft-"Depth to Water Table 4/ ft. i Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan E] Previous Application Made: [If yes,date-/C -1�------f' No F1New Construction: Yes ❑ No Q� FHA/VA: Yes E] No E] TYPE 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 dep�h--------- ---------------Capacity-_ -12 Disposal Field: Distance from nearest well_- __Q..__--Distance from foundation._ .G_._--..--Distance to nearest lot Iona Number of lines----- of each line.__.�Q.�------------Width of trench-r Type of filter material- - ---Depth of filter material 'I length___ -=-------------- i Seepage Pit: Distance to nearest�wel4----------------_...__Distance from foundation-------------------Distance to nearest lot line----------------- . Number of pits________________ -----Lining material------- -------- Size: Diameter-----------------------Depth--------- ---------------- - Cesspool: Distance from nearest well- -------------Distance from foundation------------------- Lining material--..------------------------ -- ❑ Size: Diameter------ ------------- - •..._-Depth---------------------------------------------------Liquid Capacity------------------------ gals. I I +� Privy: Distance from nearest well-------_-.__.--?----------------------------- --Distance from nearest building._..----..._---_------_------------------- Distance to nearest lot line----------------- -------------- ------------ I. � . r Remodeling and/or repairing (describe:__. -__ --- - ---- ---- ------ ----------------------------------------------------------------- --------------------------------- - -- -------- -------------------- -------------- •------------------------------------------------------------------------------------------------------------------ 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 an regulations of the San Joaquin Local Health District. �. s _ {Own r and/or Contractor St ned - ------------ - ----- -- --------------------------- -- ------- - - ---- (Signed) , n 1Pdon --------------- ---------------- • - - --- ---- --�` --------- ----------- -----(Title}-(Plot plan, showing size of lot, location of system in relation t wells, buildings, etc., can be peverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ED BY--------- ------------ DATE._.__� --- -------------------- -------------- - - ------- ----- ------------- -- � ----------- DATE----------------------------------------------------------- REVIEWED ----- -- REVIEWEDBY------------------------------------------ ----------------------------- --------- -------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------- --------------------- DATE Alterations and/or recommendations----------------------------------- ------------------------- ------------•------------------•-•---- --- --------------------- -------------- ------------- ------------ ------------------------------I---------------•---------- ----------------- ------------ ---------- --------------- -------------------------------------------------------------- ---------- I --------- -------------- ---------------------------------- -------- -------------------------------- , ----------- Date--- --- --------lQ - ----- FINAL INSPECTION BY------------------ -- -------- --- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. .200 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California -