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FOR OFFICE USE: - ------------------------------------------------------- �•�/ 'Tp4� 1 APPLICATION FOR SANITATION PERMIT - Permit No. ....................... ----------------------------- ------ --------- -------- (Complete in Duplicate) j ----------- -. This Permit Expires 1 Year From Date Issued 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. 11 JOB AD f DRESS A LOC -ION 1y',�.� �Kd-f- �+�d�.. .--------------------------------------------------- '0 -`-c�1P= �-� U"`' - - ---�- � Owner's Nam = - Phone ------------- Address------------------�---� --•--��------ -----�-�-L-C------- =- -�----- - --- -- •----n-----------•-----------------------------------------------------•---....---- Contractor's Name-- ------ ------------------ ----- ��.. --------------- Phone---•-------------------- -- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----/.. Number of bedrooms _3-- Number baths __/--- Lot.size ._.- -__ �..............._-_----.-.------ Water Supply: Public system F1Community system El Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand E] Gravel E] Sandy Loam E] Clay Loam ❑ Clay [Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-----------......._) No ❑ New Construction: Yes ❑ No I] 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- -------------Distance from foundation------------------- Material----------- --------------- _.------..-._.. ❑ No. of compartments-`--- ------Size--•-----------------------------Liquid depth--------- ------------- -Capacity------ ---------------- Disposal Field: Distance from nearest wefl-------------------D,istance 'from foundation-----------------...Distance to nearest lot line----------...---- ❑ Number of lines--------------------------- Length of each line-----------------------------iwidfh of trench------------....------------------- Type of filter material-------------------------Depth of filter material----------------------- length-------------------------------.---.._._.-- SeepaPit: Distance to nearest well._.---�e10-1--..Distance from foundation------�.a_.�-.._.D tante to nearest lot line----_ i------ t(� [ Number of pFts._..-------j---------Lining material-------x..'12.:....Size: Diameter.-i------------ -----Depth_...�-Ir -------------------- Cesspool:' -_----Cesspool: Distance from nearest well................:Distance from foundation--------------------Lining material-------------------.--------_.------- ❑ Size: Diameter----- - ---------------- - ----------Depth---------------------------------------------------Liquid Capacity- -• --------------------gals. S Privy: Distance from nearest well.......... ---- from nearest building------------------------------------------ - Distanceto nearest lot Iine------------------- --------------------------------------------------- ---------------------------------------------------------------------- i Remodeling and/or repairing (describe)---------------------------------- •---------------- ------------------------------------------------------- - --- ------------------------------------------------ ------------------ ---------------------------------------------------- --- -------- ------ a. ------------------------ -------------------- -- ----------------------------------------------------------------------------------•---•------• ---------------- --------------------------------------- --------------------- I hereby certif, fhat I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St, laI �s, and rules and rez� ations of the San Joaquin Local Health District. V (Signed,)----- � - ----------------------�_w,ner and/or Contractor) GA,,� �J ---------- ----- -- - - ----------- (Plot -- --- ' �— Ti+le (Plot plan, showing size of lot, location of'sys+em in lation to wells, buildings, etc., can be placed on reverse side). s FOR DEPARTMENT'USE ONLY APPLICATION ACCEPTED BY---- - --- ---- ------------------ ---- --------------------------------- DATE--&/ &- REVIEWED. BY--------------------------------------- ----- - --------------------------------------------------------------------------. DATE----- ------- ----------- BUILDINGPERMIT ISSUED-------------------------------------- ;1e----------------------------------------------- DATE.- ------ - ------------------------------------------------- ' Alterations and/or recommendations:------------------------------ ----------------------------------------------------------------- -----------------------------------------•----------------- .........................................•-------------------------------------------------------------------------------------------•----------------------------•---•------------------------------------------------------- ---------------------- ---------------------------•---------------------------------------------------------------------------------------------------------------------------------•--------------------------------------- ---------------- ------------- --------- ------------------------ ................ ---- •----------- --------------- ------------------------------- ------ -------- - ---- --------------------- 1 / 1 - ----------- Date- L__K-�t�--- ----------- - --- ......... FINAL INSPECTION BY:-- -------_-- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamare Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.co.