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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- .. i�- ...-..f ------------------------------ ---- ---------= (Complete in Duplicate) 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 Count Ordinance No. 549. G /W�' cS?- X30--0 rr X2Y -8 N • t r� � "/ JOB ADDRESS AND LOCATIO - -------- - - --- Qs> ---- ------------ --- - Owner's Name------�0-_ r ------------------- Phone-- ------------------ Address hone__ _-- -J -� -- -- ---------------------------------------- - ---- ----------- Address------- fQ ...�C.g._... ------- ----- --------- -------------------------------------------...-------------------.....---------- a Contractor's Name ----- -- = Phone Installation will serve: Residence O Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/--- Number of bedrooms _Number of baths ---/-_ Lot size ____-� -------------------------- Water Supply: Public system ❑ Community system ❑ PrivateDepth t Water Table -------- ft. Character of soil to a depth of 3 feet: Sand F] Gravel E] Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Applicatio'6,•Made: (If yes,date----...------------.l No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATIN AND SPECIFICATIONS: (No septic tan,11 lir cesspool permitted if public sewer is available within 200 feet.) 1 Septic Tank: Distance from nearest well-________________Distance from foundation------------------- Material__________-____-__. ❑ No. of compartments-------------------- -----Size-------------------------------Liquid depth--------------------------Capacity.---------------------- S " Disposa .------------ ------- Disposa Field: Distance from nearest well._..5;p_/----Distance from foundation___1_P_..........Distance to nearest lot gine___________.-_ gif Number of lines--------------/---------------_-Length of each line-------/�P_4___._____._._.Width of trench----.�--_--------------------.-- Type of filter material-------- _____Depth of filter material_____/__%..........Total length___-f-Q-1?_________________________ Seepage Pit: Distance to nearest well----------------------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. Privy: Distance from nearest well-----------------------------------------._ --Distance from nearest building.----...______.__.________________--- ❑ Distance to nearest lot line----------------- ----------- ---------....-------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):-------.__ ___________ _ __r_-__._ _ - ----------------------•----------------------------- ----------------------!�- -�f --------------------•-------------------------------- -----------------------•--•-- !/ ----- ---•---------------•------------------------------------------------------•--------------------------- ---- -- ------------------------------- ----------__-------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State and rules and regulations of the San Joaquin Local Health District. ---- ----------------- - ----- -------------------------------------------------------- nd or Contractor (Signed)-- ----- ----------- �-�------ - -- - -- Pe+ / ) -------- ----------------------------------•------------ ---------------- (Title) (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- --- - ------ --- -------- - ----- -------------------------- DATE-- ------- --------------------------- REVIEWEDBY--------------------------------------------------- ----------------- ------------ --------------------- ---------------- DATE-------- ----- BUILDINGPERMIT ISSUED-------------- -------------------------------------------------------------------------------------- DATE.-------- ----------------- --------------------------------- Alterations and/or recommendations------------------------------------------------ ------------------'~------------ ------------------------------------------------------------------------- -•------------------------------------------------•---------•-----------------------------------------------------------•-------------------------------------------------------------------------------.--------.---------- ---------- --------------------------------------------- -- ---------------------------------------- ------------------------------------------------------------------ --------------------------------------------------•-- FINAL INSPECTION $Y:__�/rC �fi� ---------------- Dste _�`_ '_�C. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.