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---------------------------------------FOR OFFICE USE: - - Permit No. ..tf APPLICATION FOR SANITATION PERMIT ---- - (Complete in Duplicate) Date Issued . 4 I 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�all the work described. This application is made in compliance with County Ordinance No. 549. I off- Z? AJ- H f G-ff e tl►4 4 JOB ADDRESS AND LOCATION- -' Owner s Name_._-__--,1_A � --------- ._. Phone-------------•-------•--•---------------------------------------- ----------- Owner s l --- - °�----------------- i ----------- Contractor's Name___._.__.______.____._____ - Installation will serve: Residence 1] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ r Number of living units:.------ Number of bedrooms _ '.-- Number of baths ___ Lot size ------ ---------------------------------- -- Water Supply: Public system ❑ Community system ❑ Private_] Depth to Water Table 9-0-_ ft. ^ k Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E] CI Adobe Adobe❑ Hardpan,[] E n Made: 5f yes, ----) No ❑ New Construction: Yes ❑ No [r] FHA/VA: Yes ❑ No ❑ y Previous Application 1 Y . TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.} r Septic Tank: Distance from nearest well-----_--------_-Distance from foundation--------------------Material-------------.-___._.------------------...______. [ ❑ -Size--------------------------------Liquid depth---------------- ---------Capacity-•----------------- . No. of compartments_______________________ _ Disposal Field: Distance from nearest well___-.----__--. -Distance from foundation--------._---_------Distance to nearest lot line_________________ Length of each line----------------------------Width of trench--------------,---------------- ❑ Number of lines----------------------------------- g Type of filter material-------------------------Depth of filter material---.-------------------Total length --------------------•----------• ` j Seepage Pit: Distance to nearestll/ we �_______..__Distance from foundation__�a__.________Distance #o nearest lot line---------- _______ � Number of pits--- __.-------Lining material- � .w 5i ze: Diameter._.31- ------Depth.''z------- ------ -- Cesspool: Distance`fi•oni neare�t well_________________Distance from foundation_._---------------- Lining material__.__.___..-__.-.-..----------------- �- # 1�' ❑ _--._Liquid Capacity--acitY --------------- - gals. ` 5iZe: Diameter---------- ------- - --------------;.Depth =___- .._--------------------- - - -------- Distance from nearest well--------------------------_-------_- - ----_._Distance from nearest building ---- --------- Privy: ------------------ Distance to nearest lot Gne__________________.-.---- Remodeling and/or repairing (describe).;I.- I - --------------------- --- - "„�.'....--a------------ ---------•--------- ---------------- ----- ----------- � --------------------- --- -------------------------- ___ - I hereby certif a I y y that I have prepared this application and that the work will be done in"a o>•dance with�San Joaquin County ' ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ----------------- ._(Owner and/or Contractor) 6gy:---------------- ---------------------------•---------- n---- -- - - - - ----------------------------- ------------ ------(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 DATE-//-.-/- ---6"6------------------------------------------ APPLICATION ATE//-:/_`G6------------------------------------------ APPLICATION ACCEPTED BY---;ell _ `--------- ------- ------ DATE------------------------------------------------------ REVIEWEDBY------------------------------------------------------------------------ ------------------------------- - BUILDINGPERMIT ISSUED------------- ---------------------------------------------------- --------------- DATE Alterations and/or recommendations:-_------------------------- ---------------------------------------------- --------------------------------- -------------------------------------------------------------------------------------•------------------------------------------------------ ------- --------------- i ---------------- --------------------- FINAL INSPECTION BY__ ___ __ ________ -------- Date.f_. ------------------------------------- ____ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hassllon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.