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FOR OFFICE USE: - ------ ------------------ -------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. . .... ...__ ------------------------------------------------ ----- (Complete in Duplicate) / This Permit Expires 1 Year From Date Issued Date Issued _ l 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--------- - -•-- - ---- - -------- --- ---•--•: i------•---:- a- ----------- Owner's Name-------Q0 -- - ------ Phone___Sz_K'L1_'_--71-------- Address -- - <•- �� -.. Contractor's Name =d--------- ----- I'hone. -------------------------------------------- - - - Installation will serve: Residence K Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms __9__ Number of baths .� Lot size Water Supply: Public system ElCommunity system ❑ Private K Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel [] Sandy Loam [] Clay Loam ❑ Clay ❑ Adobe,] Hardpan ❑ Previous Application Made: (If yes,date.__.__--- _.._.) No KG New Construction• Yes g] No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ( (No septic tank or cesspool permitted if public sewer is available within 200 feet.) P Se ti Tank: _."t_ Distance from nearest well___ � __U_ Distance from foundation__--.C_0--------Material----- No, of compartments--____2----.-__.__._ ze___ Si .J.A_�JS_ -___Li� th_--_____. ._ i ` quid de p. � Capacity Disposal Field: Distance from nearest well------5'O/.-Distance'from foundation-__/6-----------Distance to nearest lot line----------------- Number of lines---- --------- •-- - Length-of each line------------ 5__ ----_Width of trench--------- ------- r Type of filter mte arial___ .----Depth of filter material---.____�/_9�r_._Tota! length----------1-s_��`1------------------ r Seepage Pit: Distance #o nearest well----._1 AP-----Distanc*e from f undation_____f_�? --_ Qistance to nearest lot line________________ Number of pits__.__ry�----------Lining material_' Size: Diameter_____ ,7..�'____Deptn____... ------.-___.___ Cess oo€: Distance from nearest well---------- ------Distance from foundation_-_-.------- -----...Lining material__..--_.._.--_.___ El Size: Diameter_------------- --- --------------Depth------------- ------ -----------------------------Liquid Capacity------------------------ --gals. Privy; Distance from rea�est well----------------------------------------------...-Distance from nearest buildin 6 g❑ Distance #o Heaves# lot line----- -----------=-- -=--- -`�----- -----•--•---•------------------- _ x Remodeling and/or repairing (describe):---------------------------------------1-------------------------------------•-------- --------------------------------- -----------------------•------------ ---------------------------------------------------- I N -i-s---------------------------------------------------7 r --- ------------------------- ---- 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 and regulations of the San Joaquin Local Health District. (Signed)_.._ 4 ..____.(Owner and/or Contractor) By: �---- _._-_ , (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---- ----- ---------------------=-"ATE--------------- REVIEWED BY - -------------------- ----- DATE----- BUILDING PERMIT ISSUED-------------------4 _ --- -------------------------- ------------------------------------------ --- ------------------------------. •DATE--------------- --------------------------------- Alterations and/or recommendations:._.-`_________________________.._ - -------------------------- ------ - r -------- ---------- ------------ -- -------- ------------------- ---- --------------- --------------------------- ----- --- -- ------------------------------------ ----------- ------------------- `l 3= ---------------------- ----- ------------------ - 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