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FOR OFFICE USE: ------------------ ------ --------- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ........................ ---- -- --- -- ----- ---- -- (Complete in Duplicate) __ _.., - PDi�,1='. r .� ,; Date Issued o ___-F 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 County Ordinance No. 549. JOB ADDRESS AND LOCATION--- Ii�. --3 �a.�------------- h�c' wrs Owner's Name---' �� ------------------------------------------------------------- Phone------------------------------------ - Address-----------° .................---------�-`-- T--------------------------------------------------------------------------------------------------------- ------------------------------- Contractor's Name----------- ----------'----x--------i-----------------------------------------------------•--------------- -- Phone Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __.I___ Number of bedrooms _ ____ Number of baths __l____ Lot size ---- -S -r--------------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 0- ft. Character of soil to a depth of 3 feet: Sand ®Gravel L❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date--------- ..__.___.) No New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ..(No-septic tank or cesspool permitted-if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__ 1.f____Distance from fou ndafion_6P__--________-Material..-0�---------------------- No. of compartments_...�a___-__-__•,_.____Size__�.l----x_ __ _Liquid depth____-_``11........---------Capacity...l__4_p�_j_____ b� e ` /!� Disposal field: Distance from nearest well-,�.�-._--__._Distance from foundation___+!_.._________.Distance to nearest lot line__/!Z"` Number of lines___________________ __________Length of eachline_^ �i °`Z -Width of trench.. 9__��_.____.-__..____._. Type of filter material____ �i. ,..---Depth of filter material_._lff.'----------Total length___-1 _� Seepage h Pit: Distance to nearest well______________________Distance from foundation___________-._.-__.Distance to nearest lot line--.-----_--__..._ Number of pits----------------------Lining material---------------------- Size: Diameter----------....-........Depth--------------------------------- I 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)------------------------------------- ------------------------------------------------=-------------: _----------------------------------------- = c. --------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------- -------------------- ----------•------ ---------------------------------------------------------------------------------------------------------------------------------------------------- -------- ---- ---- - - 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 rul and regulations of the an Jo quip Local Health District. Si ned .__(Owner and/or Contractor) ----------------------------------------------------------- -- -------------- - -- -------------- ------ � Y=•-•-•----•-------------------------••-=•---•--------------------------------------------- --------------------------------—----- tt a :---__- - - =-_ ------ i (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 BYt Q ` f ` DATE 7---- ----------- --- I REVIEWED BY---------------------------------- ------------------------------.-. - ----------------------------------- DATE----------------------------------------------------- --- BUILDINGPERMIT ISSUED----------------- -----------------------------------------------------------------------------------. DATE------------------------------------ - ------------------ Alterationsand/or recommendations:----------------------- ------------- ---- ---------------------------------- -------------------------------------------------- ----------------------------- I ------------------------------------------------------------------------ ------------------------------ -------------------------------------------------- ----------------------------------- ------------------------ -------------------------------- ---------------- --------------------- , ------------- --•-------------•------•------ -------------------------------------------------------- FINAL INSPECTI Y:.. y Date ...'.L 67----------------- 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 F.P.c o.