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FOR OFFICE j,JSE: APPLICATION FOR SANITATION PERMIT Permit No. _ 7-__ �_ -------------------- -------- ----------- -- ------------ (Complete in Duplicate) 1• -------------------------------- This Permit Expires 1 Year From Date Issued 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 County Ordinance No. 549. JOB ADDRESS AND LOCATION--------1-S/J ------ -------------------------------------------------------------------------------------------� Owner's Name-------•------r-'n------- - •-•----------------------------------------------------------------- Address------------------- ----------------------------------Address-------------••----�`'/ � - ----------------------------------------------- Contractor's Name________ ____ ._ ______ .__,.., -_ .._-_- Installation will serve: Residence R' Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J____ Number of bedrooms j-___ Number of baths ---/-- Lot size ----400------_X_:A2PiP- ,. Water Supply: Public system [ Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ER—Hardpan ❑ Previous Application Made: (If yes,date------------------__1 No g— New Construction: Yes ❑ No E' FHA/VA: Yes ❑ No []' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well-----------------Distance from foundation--------------------Material-----------.---_-----------------------.______... No. of compartments--------------------------Size-----.--------------------------Liquid depth--------------------------Capacity----------------------- Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----------------- L~ __�c Number of lines-----------------------------------Length of each line------------------------------Width oftrench.-------------.----------------- \ Type of filter material----.---- ----- -----_---Depth of filter material-----------------------Total length___.____._.___________..______________--._ Seepage Pit: Distance to nearest well__&Lt_...-----__Distance from fo ndation__/9_�.__..__.Distance to nearest lot line-4 .--_.__..._ Number of pits....../---------- _Lining material_ _�.. ...size: Diameter- --- Depth X --- ------------- Cesspool: Distance from nearest well-----------------Distance from foundation___________________Lnng material__._._______________________________ Size: Diameter-------- ------------- - Depth------------------------ ---------------------------Liquid Capacity----------------------------gals. Privy: i ell well-----________________________________.__.____._Distance from nearest building--__.---_..______-_._-_______-..--- ❑ Distance to nearest lot ine_-_ - .-- -------------- .-------- ------------------------------------------------------------------ ------------------ ------ Remodeling and/or repairing (describe :--------------- ----- ------------------•---•---------- ----------•-----------•-------------------------------------------------------- ------------------------------- ---------------------- -------------------------- ---------- -------------------------------------•--------------------------------•-----•--------•------------------------------------------------------------------------ ------ ------------------ --------------------------------------------------------------------------------------------------------------------- ----------------------------------------I----------------- I - --- ------- ----- -- I hereby certify that 1 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 -------------------------- c�-1 r------------------------------ --------------------------------------------------- -.(Owner and/or Contractor) By:-------------- _..--•--------------------------------------------------------------------------------(rifle)----------------- - -------- - ---------r- - - - ------- --- (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------ ----------------------------- REVIEWED BY------------------------------------------------------------------------------ ------- -------------------------------------- DATE--------------------------------------- - -- ---------------- BUILDINGPERMIT ISSUED--------------------------------------------- ----------------------------------- ----------------- DATE--------------------------------- --------------------------- Alterafions and/or recommendations:__.__//06G--- _ f____ -_ --� �°crr<T? -------------------- -•---------- ------------- -----------------------------------------------------------------------------------------------------------------•----------- ---------------------------------------------------...------------ t -------•------•--------------------------------------------------- --------------------------•---•-- ----------------------------------------------------------------------•--------- ------------------------------------- -------------------------------------------------------•---------------------------------- ----------------------------------------------------------------------------------------------------------------------------------- --------------------------------------- ---.----------- -------- ............ ----------- -------------- ----------------- --- ---------------- ------------------------------------------ --------------------------------- FINAL INSPECTION BY:-----------�� -------------------- --- ------ - Date------------- � ��Z .G.--------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California F.P.CO.