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- -- - J FO OFFICE USE: .. - // --------- ---- � --------- �,. . . APPLICATION No. FOR'SANITATION PERMIT ' ,„ Permit --- ------ ._/.... .......... --------------------------------------------------------- (Complete in Duplicate) --- ------------------- This Permit Expires 1 Year From Date Issued Date Issued .._�_____.__.,..1__ 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 -OCT N-------- �.l�- _�--------- ------- -- Y ---------? Phone------------------•----------------- Owner's Name -- ---- ----- -- --- ---- ---------•--- -------- AddreAddress ss - - - -------------------------- r . SCP Contractor's Name--- - -------- ---•---- ------------------- -------- -------------------- -----:Phone Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __ _ Number of bedrooms 4::2... Number of baths ---l-- Lot size --------S-74- ---e-tQ-------------------•- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table V0- ft. Character of soil to a depth of•3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe)K Hardpan ❑ Previous„AApplication Made: (If yes,date----- _-) No New.Construction; Yes ❑ No ` FHA/VA: Yes ❑ No ❑ TYPE- OF INSTALLATION AND SPECIFICATIONS:; t (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i p • Tank: Distance from nearest well________________Distance from foundation_---------------_...Material---------------------------------------.._______- No. of compartments------!---------------- ---Size-------------------------------Liquid de`h ------------------------Capacity----- ---------------- '_-.Distance -------------- `' Disposal Feld: Distance from nearest well �.._Distance from foundati n--- to nearest lot I�{e p Number of lines------ _____ # Length of each line__- ?--�_____r�_...Width of french.__iZ_ ___ ------------ Pit: O Type of filter material_ � � __Depth of filter material,___,�I_._k____Total length----________________�__�- - W S'e g,� Pit: Distance-to nearest well---------------------- from foundation_______-____-____.,Distance to nearest lot line_________________ Numb,pr, of pits----------------------Lining material------------:----------Size: Diameter-----------------------Depth--------------------------------- -k I ,. } 7 Cesspool: Distance from nearest well---------------_-Distance from foundation--------- ._-_.. ...Lining material_._____....._-.----.__.__________.__-. . ❑ Size: Diameter------ -- - --------------------------Depth------ ---------------------- ----------------- --Liquid Capacity----------------------------gals r . Privy: Distance from nearest well_________________________________________________Distance from nearest building-------------------------------__...___._. I ❑ Distance to nearest lot line------------------------------•------------------------------------ --------- ----------- ---------- ----------------------------- Remodeling and/or repairing (describe}---------------------------------------------------------------------------- ------------*- ------ F --------------------------------------------- ----------------•------------------------------------------------------------------------------------------------------------------------------------------- - - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, a law , and rule and re ations of the San Jo Iuin Local Health District. (Signed)------ ---------- - ---------------------- - -----------I--------- - --- -- --- -------------------------------------------------- Own r and/or Contractor] BY: -----------------------------------(Title)-- -- - - ---- --- ---- - ---- - - -- - ------..-------- (Plot plan, showing size of lot, location of system in tion to wells, buildings, etc., can be placed on e se side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.-_ a ____________'DATE �' - -_-.__.-__-- - --- REVIEWEDBY--------------------------------------------- --------------------------------- --------------------------------. -------- DATE-- •------------------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------- ...... DATE--------------------------- ----------------- --------------- Alterations and/or recommendations:_-------------------------------------------------------- ' - ",! ---------- ----------------------------------------------------•--------------- -------------------•-------- ---------------------------------------;-;----------•------------------ ----------------------------I------- --- r► X,. FINAL INSPECTION BY-. Date _ /-- --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 west 9th Street rt Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O. L�