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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. .. - ------------------ ----------- -------- (Complete in Duplicate) 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. JOB ADDRESS AND LOCATION__% 0 2 4-W ------------------ ------------------------------------------•-- ----•-------------------------------------------------------------------- Owner's Name-•_ ------ ------------------------------------------------------------------- --------- --------------------------------- Phone------------------------------------ Address...... -----------------------------------Address--_... -- --- Contractor's Name___-�_ �-S ----- Phone----------------------------------- Installation will serve: Residence 2--`Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: )______ Number of bedrooms _-.2,Number of baths _.L____ Lot size __- _.G_____________________________________ Water Supply: Public system UT�Community system ❑ Private ❑ Depth to Water Table -------- f+. 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 [Er" New=.Constri]coon: _Yes_Q_No... FNA/VA: Yes ❑ No P�'� TYPE OF INSTALLATION AND SPECIFICATIONS: ,.-. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` Septic an Distance from nearest well_________________Distance from found'ation------------------ Material____._.______________.-.___-_____._------._____- I No. of compartments--------------------------Size------------------------- ='_Liquid dep'th---- ---- ---'-----------Capacity---------------------- Disposal Rel: Distance from nearest well------------Distance from`foundation_/(j__F-----------Distance to nearest lot line �--_J_______ Number of lines________ _____ _-_________Len th of'each line______- 9 --Width of trench.-----�� '. ----- FA-AVIVType of filter material-_rTP.rA--------___Depth of filter material.... ir_`_____.__._Total length----2�3p ____.________________ O $eepag Pit: Distance to nearest well.- pistancfrom foundation__L�_�A_.___.Distance to nearest lot line__67�_-___-- dumber of ----------Lining material-_._!cic_ ----.Size: Diameter__��_d.............D,pfh2J— Distance from nearest well---------- Distance from foundation--------------------Lining malarial-----------________________________- . ❑ Size: Diame'!3r--------------------------------------Depth_----------------------------------- ------------.-.Liquid Capacity......`.---------------------gals. Privy: Distance from nearest well---------------.----------------------------------Distance from nearest building_________.___.____.___________-------- ❑ Distance to nearest lot line -------------------------------------------------------------------------------------------------------------------- I Remodeling and/or repairing {describe):-- ------'-----------------------------------------------------------------------------•---------------------------------•------------------------------ --------------------------•----------------------------------------------------•-------------------------------------------------------------------------------------------------------- -------'------------------------- F i -------- ------------------------ ----------- ---- --------------------------------------------------------------------------------------------------------------------- ------------------------------- ----------•---------------- I hereby certify that I have prepared this application and thdf"the work will be done`in accordance with San Joaquin County ordinance$, State la ar� rules a r ulation of the San Joaquin Local Health District. '------'------/---'---[Signed) _- (Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------------------------------------(Title)------- - --------- -------- ----------- ----- -- ------------- (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. REVIEWEDBY---- ---------------------------' ---------------------------------- ---------------------------------------- DATE-------' BUILDING PERMIT ISSUED--------------------------------------------------------------------------------------- --------- D TE------------- i Alterations and/or recommendations:---3-_l-/. -6-------- -+ ----------------------------------------------------------------------- -------------------------------- ------------- -- --- ---------------------------- ------------------------•---------------------- --------------•---------------------------------------------- -- ------------------------- � �/FINAL INSPECTION BY:. - -'------'--- ----'----------- Date ' SAN JOAQU LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,ColFfornia Lodi,California Manteca,California Tracy,California F.F,0 Q.