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FOR OFFICE USE: --------- ------ --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT r Permit No. ----------- ----------------------------------- (Complete in Duplicate] _.._--..._ This Permit Ex ires i Year From Date Issued Date Issued ------ (0_.3- :��-_,-,�� r�=.,.rte 2--04,-0 4v 3 Application is hereby made to the San Joaquin Local Health District for a permit to construct and instal(the work herein^ described. This application is made in compliance with County Ordinance No. 549. ;I St I)� p 1 JOB ADDRE AND LOCATIO �� ++ :--------L� ---- -- -- ---- ---------y-'�------a F-----�---/-U-5��_tv----FD . Owner's Name-------------- (=-------- 2 E_ 1� '----- --------------------------- - Phone------------------------------------ Address------------------ -------------------------------•---Address------------------ ----`----- -1-1 C1�------- Contractor's ------------- ---•---------- -------- ...... Phone_--------------•-----._...-------- r « Installation will serve: ResidenceApartmejfP_o_,,ee F=1Commercial E] Trailer Court E] Motel E] OtherNumber of living units: _t.____ Number of bdrooms umber of baths -- Lotrsize "".: c -._ CS.------ Water Supply: Public system ❑ Community s�stem ❑ Private Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand Gravel E] Sandy Loam ❑ Clay Loam ❑ Clay:-E] Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date_.............__._) No Ra--'-'New Construction: Yes No ❑ FHA/VA: Yes No ❑ i .c_,TYPE OF_INSTALLATION,AND.SPECIFICATIONS:_ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ,l Septic Tank: Distance from nearest well--5_- _-Distance from fourirdationj ----------- i`. ,> No. of compartments-.... -----------Size- _xCr-xt�__Liquid depth_ , ------Capacity_____-�------___ Disposal Field: Distance from nearest/well _ _.__Distance from foundation... -__-__.Distance to nearest lot line_{__,_ r Number of lines_____ _( __.__ __.-_._Length of each line--- 7�_�{-_..Width of french.________3�L__-_—------------ f Type of filter material--- aC .__Depth of filter material-.----- _-______..Total length----------- 75 ---.------------I •w Seepage Pit: Distance to nearest well----------------------Distance from�fo� ndation--------------------Distance to nearest lot line----------------- ❑ Number of pits----------------------Lining,material--"""�.------------Size: Diameter----- --.Depth...-----------------------.------ rn" Cesspool: Distance from.nearest:weII'_________` -Distance from foundation------------_.......Lining,materiaL_._..._._____---.-.__-_.___-_____.__ d Size: Diameter--"--a----------------------------De th--------------------------- -----------------------Liquid Capacity----------------------------gals. .' Priv Distance from nearest well-------------------------------_-._._7-._Distance from nearest.building ❑. Distance to nearest lot rineltails 'ss` -- j ;< `3 Remodeling and/or repairing (describe}:-----------------------------------------------------I--- =---- --- ----- `'�-' -- --------------------------------•-•------------- I ' ----------------------------------------------------------- --------------------------------------------------------- i - ----- I t� r ,I I a---- ---------------------------------------------------------------------------------------------------------------------d-----------------------------------------I-------------------------------------------------------- I ----- 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) ./ '_' 1 ----------------- -------------------------------------- r - (Owner and/or Contractor) � - Sy:----------- ---------------------------------------------------------------------- ---------------------------------------ITitle)----------------.---------- - 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 BY - DATE Q.------ --------------- REVIEWEDBY-------------------------- -------------- - --------------------------------------- DATE-------------------- BUILDING PERMIT ISSUED---•--------------=------------------------------------------------------------------- ------------ DATE--------------------__----- Alterations and/or recommendations:------------------------- --------- ---------- -------------------------------------------------------------------------------------------------- / i FINAL INSPECTI Date.- �D / �-- - ------------------ SAN -------- -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 i