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FOR OFFICE USE: --------------------------------I---------—----------- - APPLICATION FOR SANITATION PERMIT Permit No. ...�....... -------------- --------- -- -- ------------------------ (Complete in Duplicate) 7 Date Issued ------ ------------------------ ___ 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. ,�J r - JOB ADDRESS AND OCATIO /__ � __ ________ _ _____�__C� ''�_F'- Owner's Name --•- --------• --- - --------- --------- Phone----------------------------- Address------------ -- a----- ---- ------------- •-----------------------------•------------------------------------------ Contractor's Name---- .�'` 4 - ----------------- Phone----------------------------------- Installation - � � ---- - ------------- Installation will serve: Residence [ Apartment House [] Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __./___ Number of bedrooms-7�_._ Number o aths __I_._ Lot size ------------------------------------------------------------ Water Supply: Public system F] Community system El Private Depth to Water Table ........ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ 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 welt_________________Distance from foundation--------------------Material___________._.________________.._._.______- ❑ No. of compartments--------------------------Size--------------------------------Liquid depth----------- --- ---------Capacity---------------- / Dispos field: Distance from nearest well._._JP�__Distance from foundation------/_t2__--Distance to nearest lot line._ Number of �'•� lines----------/-- ----- ----------Length of each line------fda_-___._..______.Width of trench..__ _._______________._ Type of filter material- _ 47t _ ___..__Depth of filter matenaL�f_ ______..___Total length _____ _ -__ g �p _ _______________________________ �� it: Distance to nearest well_____ ______Distance from foundation----1d_......... Distance to nearest lot line----°.......... / Number of pits----------- Lining material- -- ---- Size: Bja+>4c>irer ---X__io..'_--Dept h-..... S- ----------------- 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 (descr;b�e}------�- -- ---------------------------------------------------------- ----`"`--_�-1-��- -- -------------- ---------------------------------------------------- ----------------------------------- ---------------------------------------------------- ----`---- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Sta ws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------- -------- ------------- - vvner and/or Contractor) -- RY -- =- - ------------------`--------------(Title)-------------------- -� � r� (Piot plan, showing size of lot, location of system fn relation to wells, 6uildi6gs, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY,-'_. _______________________________ DATE---- _._ - - - -- - - -- ------------------------------- ---------------------------- REVIEWEDBY------------------------------------------------------------- ------ DATE-------------------------------------------------------_.. BUILDING PERMIT ISSUED---------------------------------------------------- ------------------------------------------------- DATE-------------------------------------------- --------------- Alterations and/or recommendations:------------- ----------------------------------- •------•------------------------------------------------------------------------ --------------------------- ---------- -------------------------------------------------------------- ---------------------------------------------------------------------------------------------------•------------------------------------------------ ----------------------------------------------------------------- ------- ------_------------------------------------------------------------------------------------------------------------------------- ------------- FINAL INSPECTION BY: - ---------------------- Date--- ------------------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lotti,California Manteca,California Tracy,California P.P.cci.