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FOR OFFICE USE: ----------------------------------------- --------------- APPLICATION FOR SANITATION PERMIT Permit No. - -1 { --- _ ------------ ---------- (Complete in Duplicate) _ p This Permit Expires 1 Year From Date Issued Date Issued ____ f p -rein — "'""'Application-is`liereby`made`to the'-San-Joaquin xLoca I-Health District-for a-permit�to construct and install.thewor heresn escn ed. { This e a_ plication is made.in compliance-with County Ordinance No. 549' JOB ADDRESS AND LOCATION01� �-- �►_-IAB-- - ------- ' A4A I �® E Owner's Name-- � `-' /IC ,.ra:— •-aG,C�. .._Gij/� Phone. ��- - _� Address 1�--0_-----�-Y- L __t`t{_Y_ i1 1 w '' -------- --------•-------------- Contractor's Name-- ------ --- 1 ) i t' ---•------------- Phone-4 ,4Z1 P r- Ct . Installation will serve Residence:. Apartment House [ ' Commercial ❑ Tr�leri Court ❑ Mote! [ Other ❑ Number of fixing units _ '- Number of bedrooms __ Numbertof baths --------•--•------------------------ Q Water,Supply: Public system ❑ Community system E]' EPrivate Depth to Water Table ..5 67 Character of soil to a depth of Meet: ,Sand ❑ Graver[] Sandy Loam❑ Clay.�Loam ❑ C1ayX Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---------------------) No New Construction: Yes-El` No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or-cesspoolmpermitted4if�public-sewer is available,within-200 feet.),„„, Septic Tank: Distance from nearest well Stance from -foundation--------------------Material------.-____._._____._.________________________- ----- Size-------------- ` - i' -------Capacity----------------------- ❑�GIS�� No. of compartments----------------- __- -- --------Liquid de th__._.-_._..___-.-- � 1 � Disposal Field: Distance from nearest weil0._____Distance from :foundation---/P_--------Distance to nearest lot line----6`-1___ Number of lines-__ ____ _ ______ ___ Length of each line-3-0---- - Width of trench____ . `_____.._____------ 9 , ------- Type of filter material__- -------Depth of Cfer.maaferlal-__-1__�_.-______..Total length______6CQ__________________________ p See a e Pit: Distance er of n{ares+ well__ p_Q_.______Distance mrm foundation___1�---------Distance to nearest lot line__:__-. t ,nrrjj �� Size: Diameter-- _ . De th_-._ ___-_. i pits--- Lining material_ P -------------- Distance from°fou,ndation__._...-_-__...-_..Lining material...._---_______.-._.___.____________. Cesspool: Distance from nearest well-- { '..-' "'."❑. ize:,Diame#er 'r"< Depth- _= T--= ==-`_--- f---- ===Liquid,.CapacitY gals. I Privy: Distance from nearest well __________________________----------------------Distance from nearest building---------.._______________-________..--. i ❑ Distance to nearest lot line--------------- ------------ ------------------------------------------------------- ------------------------------------•-------------- Remodeling and/or repairing describe): ------ -- ------ -' -----------------------------------------•------------ I ---------------------------•----------- -------------------------------------------------- ---------------------------------------•-------------------,_-------------------------------------------- ------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Co . J ordinances, State rules and regulations of the SJoaquin Local Health District. (Signed)---------- ---- -- --------- Q ---------------- Owner and/or Contractor) B ----- --- ----- 'k: --------(Title). g-�--r---------------- Y:-- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed f reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------ ------------------------- ---------------------------------------- DATE----------`3 / r �/ REVIEWEDBY---- - -------------------------- - -- --------------------•-- ------------------------------------------------------- DATE----------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE-------------------------- -------------------------------- Alterationsand/or recommendations--------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------- ----------------•----------------------------------------------- ---------------------------------------------------•-- - ------- ---------------------------------------------- ------ -------------- ----------------------------------------------------------------- ---------------------------------------- --- ----------------------------- ---------------- ------------------------•--- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------- ------------------------ --- - ---------------------------- ----- - -------- FINAL INSPECTION BY:.. . -----I---------- Date--. --------- ---------------------------- -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Avo. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC. {