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FOR OFFICE USE: ✓' ------------------------ .................... ........................................................ APPLICATION FOR SANITATION PERMIT Permit No. .1-7a-21 ------------------------ ------7--:------- (Complete in Duplicate) v f Date Issued ......................................................... This Permit Expires 1 Year From Date Issued t OSS'-(70--p � Application is hereby made to the Sen Joaquin Local Health District.for a permit to construct and install the work hbrein desc e This application is made in compliance with County Ordinance No. 549.I 4W y�� JOB ADDRESS LO ATION� _ -- Owner's' No -- r - Phone - - .......... �y o Contractor's Name......-.- - --- .. - --..-..---.-. Phone----- ---•--......-........ Installation will serve: Residence Apertmen House ❑ Commercial ❑ Trailer Court ❑ M�o�tel�❑ Other ❑ Number of living units: .-`--- Number of bedrooms -- -.. Number baths -_f- Lot size ---4, -4 C._. -------:- � 1 Water Supply: Public system ❑ Community system ❑ Private [J Depth to Water Table ---.--.- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Cley Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Applicaf ion 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: 1 Distance from nearest well-----------------Distance from foundation....................Material............_-------.................. .......-.. ' ❑ No. of compartments---- _Size--..-....------------------'---Liquid depth------------...-----------Capacity---------•-...-�.. I Disposal geld: Distance from nearest well.....s6.....Distance from foundation-----,��-_...-.Distance to nearest lot line....-5-....... Number of lines.....-.-...1... .. .. Length of each line-...--,�_Q.-Q._..-----...Width of trench.--.z ...... --------------- ria. . 1 �rJ ------------- - Type of filter material-- . .r.-. -..1....-.Depth of filter material..- ...Total length..........410-Q-----................ Seepage Pit: I Distance to nearest well.......__-----------Distance from foundation--------------------Distance to nearest lot line..............._ ❑ f Number of pits------___..........Lining material.......................Size: Diameter.......................Dept h...............-............. Cesspool: Distance from nearest well-----------------Distance from foundation.-..........: --..Lining material...........-........................ ❑ Size: Diameter-----------------------------_-------De tK..........................-..................._...Liquid Capacity al Privy: Distance from nearest well..........-----_................................Distance from nearest building-.-_...........-----------_.,........... pt Distance to nearest lot line....................................--------------------------------------------.__:------------I-------------------------------------- Remodeling and/or repairing (describe):----..-_................-------........-------------...-_-.-..-•---•-------t:-----•-------••------------------------------------- ...------.......:..........- - •------------ ----------------------.-...-.--................------•--••--•-----------•-----••---'------•---------•-•--------------_.-..---'------------•-------------'------•-- ...............-------------•------------------•----------------------------------------------------••-•--•---•-..-..-..------`•-----.....--•-•----------------------'----....----•-----'-------------------...-- , 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 Sen Joaquin Local Health District. (Signed)-----�------- ---- -------------- -- ------ -- ............................................. d/or Contractor) tBy[-- - - . . ..... - -- ----------- ----_........(Title)....-........-.-..-.....--- I.............. plan,ihowing Sim of lot, location of system in.4ation 4o wells, buildings, etc., can be placed on reverse side 1, FOR DEPARTMENT USE ONLY •-"—"APPL1CATI1ON'ACCEPTED gl'�.....---....`— ..� ...--. - - --------------- --_.................... ----------•.............._..-.-.. DATE..... .......'.- -'--:=..:r.._�--•---.....-..... REVIEWEDBY-----------------------------------------• ------....-----•---•-•--•-----. DATE.-.......................................-............. BUILDING PERMIT ISSUED............-•---__..................................---_...... L....................-... DATE-----------------------------------------•-•---- Alterations and/or reeommendeflons:-----}':.-..` - ----- - -..._:....--,.._...`-�-----'---•------•------•-.-_.-...------••---•-----------------------•----- ......----.....-....... f ................................................-----------....... ........`-:..... - .� ' FINAL INSPECTION BY:./ ------------- Date...s�3.�--?.- b._ ,-USAN JOAQUIN LOCAL HEALTH DISTRICT / ( 11601 CHazo116n Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 1 _N, Stockton,California Lodi,California Manteca,California Tracy,California I f AS 9 I[EV18ED 0-89 3M 3=63 F.p.CD.