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FOR OFFICE USE: �. .s, -------------G-------- � -._3- . - APPLICATION FOR SANITATION PERMIT Per No. --�__�_•�- ------- --- ----------------- .. ---------------- ------- --------- --------- (Complete-in Duplicate) j 2 ---------------------- ---------- __-_.._-...._. This Permit Expires 1 Year From Date Issued Date Issued __________ _____`-7 Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the or herein described. l This application is made in compliance with County Ordinance N`" JOB ADDRESS AN ATIO '• 1�7- � - f �'� =�l-/C -`---- Owner's Name , /e.------- - Phone �' r .` ' Address -- -------------- mss._.... + Contractor's Name--'-7ResencfeA;��.Appar4tment t7 Phone_�#ri�l�' G" Installation will serve: ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .._ Number of bedrooms _. _. Number of baths_ Lot size Vel _-r___.__.._. Water Supply: Public system ❑ 'Community system ❑ Private' Depth to Water Table 7S'__ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeiK Hardpan ❑ Previous Application Made: Ilf yes,date_------,._..._..... ) Nd.4 New Construction: Yes ❑ No FHA/VA: Yes ❑ No t , 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 ------------------------------.----------------- ❑ .( k y No. of compartments ----- ----Size.-------- --- - -----------Liquid depth--------- ----- ------- Capacity----------------------- Disposal Field: Distance,from clearest wefi.APO------Distance from foundation-_-. Vy __ . ........Distance to nearest lot line_.��__ ____ Number of lines_ YU .� Length of each line__.. ---- Width of trench.__E __________________ / Type of filter material- -___Depth of filter material_.--.-1_. ..-----.Total length--_-_-._7,5__--11------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation------------------- Distance to nearest lot line----------------- El p Dumber of its___ ------------------Lining material------ - ------------- Size: Diameter.-------- ------------Depth----- -- --------------------- 3 Cesspool: Distance from nearest well----------------Distance from foundation.-- ----- Lining material__-__.---------.____--_--_-._--__-___. ❑ S_1ze: Diameter)-- -------------- ----------------Depth--------------------- ------------------=---------Liquid Capacity----------------------------gals. it Privy: Distance frorri nearest well-------------------------- --------------------_Distance from nearest building------------_---------------------._--. ❑ Distance to nearest lot line------------------ -- ------ ---- -------------------------------------------------------------------- Remodelin ahcl or repairing (describe):-------- ------- - -----a---.---------------------_ • i -----------------•...... :---- •-----=------••----- --------------------- --- ------------------------- ----------- ---------- .i --------------------------------------------------------------------------------------------------------------------•----------------------------------------------------- ------------ !.-------------- -------------------------------------------------------------------------------------------------------------------------------- I hereby certify That I v prepared this application and t t the work will be done in accordance with San Joaquin County ordinances, State laws, an r s and reg ions of the San J quin Local Health District. (Signed) - -r� -- --_-- -.-------• .'- -----------............._.. ...Owner and/or Contractor BY= =---------------- -------- ----- - -- - --- ---------- -----(Title)-------- - - - -------------------------------- (Plot plan, showing size of lot, to ation of system in relation to wells, buildings, etc., can be place on reverse side). t1 FOR DEPARTMENT USE ONLY i _� +• APPLICATION ACCEPTED BY___---- DATE__._.,d::� --- BY`--------------- ------ - - -------- -_--------------------------------------- ---------- - ------------------ ------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------- --I------------------------------------------------•---------------------------------------- DATE------._- --------- Alterations and/or recommendations---------- ------- - -------------------------- ---- -----------------------•-------•-------------------------------- ---------•-----•------------------------ -----------------•--------------------------------------- -------------------------------•..................----------- - ---------- --------- i1 ----------- ------- ---------1-------------- ---------- ------------ ---------------------•-------------•----------------- ------ i FINAL INSPECTION BY:------------ --._ ------------ Date--------------.-��____--- _- -_------------ --------_-- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 sycamore Street 205 West 9th Street Stockton,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press � v