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FOR OFFICE USE: IF � ---._I---- APPLICATION FOR SANITATION PERMIT Permit No. _ / ------------ --------------- ---------------------- --------------------------------------------------------- Com lete in Du licafe t P P Date Issued '-- ---=----- ------------------ ` k ........................._..__..,_..._ This Peer��m��it Expires 1 Year from Date Issued_ Application is hereby made to the San Joaquin Healfh District for a pedrmif to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. " JOB ADDRESS D LOCATkON..7r . 7•ni -- .,__ :_- d _.__ --------------------------------- Owner's Name- --- ame -•• --- - � - ------------ Phone.-------------------f-------------- � ., �. Address 11,.1 ----- -- - - ----- - ------- Contractor's Name-------- ----- ` -r .l---------' --- --- --•----. Phone---------------- Installation will serve: Residence, Apartment Hous2Commercial L] Trailer Court ❑ Motel ❑ Other - � � Number of livin - '-ts: ___o'�Number of bedrooms '.Number of baths ---yLot size ---- `"t" 3 -_'_____________________ Water Supply: Public'systerii ❑ Community sys em ❑ Private [Depth'to Wafter Table __._____ ft. Character of soil +ot de +hoof 3 fee+: Send Gravel Sand Loam Cla Loam Cla Adobe' Hardpan � zP _ � ❑ Y ❑ Y ❑ Y ❑ ❑` ❑ � Previous Application Made, (if yes,date--------------------) No ❑ New Construction: Yes ❑"No ❑ FHA/VA: Yes ❑ No ❑ f TYPE OF INSTALLATION AND SPECIFICATIONS: _ A. (No septic tank or cesspool permitted if public sewer is available within 200 fee+.) Septic Tank: Disfancelfrominearest well-----------------Distance from foundation________________...Material_/----------------------------------------------- ❑ No. of compartment-s--------------------------Size--------------------------------Liquid depth.----------- .........Capacity---------------F-----• �f Dispos field: Distance from'nearesf well---- Distance from foundation------j�Q Distance to nearest lot line--- ____...... r g . 3- Number of fines_____________�_____...____ 6._.___Length of each line____________________________Width.'of trench -- ------------------------- _ Type of filter--material___.._.__ _t_____Depfih of filter material___.-/.�__f+__.____.Total length______V_________ Seepage Pit: Distance•to'nearest well____________________-Distance from foundation__________________.Distance to nearesf lot line-----_-----.--_.- ❑ Number of pits--------------_e----Lining rriaterialr_....................Size: Diameter--------------------:,Depth-----,--------------------------- Cesspool: Distance fr' nearest ll_- bistance from foundation___._______.___....Lining material--. ______________________ ❑ P Liquid Capacity gals. Size: Diameter Depth - -- - .e/ ry Privy: Distance from nearest well______________________________.__.________.----Distance from nearest building------____----._____._:______..._..___.__. ❑ ............ ... 0. Distance to nearest lot line -- -- ---------- -••---------------------------------------------------- ---°- ---- -------------- - ,. Remodeling and/or repairing (describe)__________________________ ' ---------------------------- ------------------------------------------------------------------------- -------QJf' ------ ----- ----- --- ---- -- ---------------------- I ar ----------- -•---------------------------------------------------------------------------------•-------------- -------- -•. --- -- ------------- 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 nd rules and regulations of the San Joaquin Local Health District. ' (Signed) ----- - ----------------------------------------------------- --------------------------------- and/or Contractor .4 BY=----------- ------------------------- =--- --- ---------- - - ---------------------------- W.- (Plot ---------- -. -- :r (Plot plan, showing size of lot, location of sys em in rela ron to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY t �� APPLICATION ACCEPTED BY... .. _____ DAT:E------ _�� - -- _G REVIEWEDBY------------------------------------------------------------------------------- - ----- ------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------- ---------------------------------- DATE------------------------------ ------------------------------ Alterations and/or recommendations:--------- ---------------------------------- - ------------------------------------- -------------------------------------------------------------------------- I FINAL INSPECTION BY:..... � ! ---------- --- Date__. .�_ --------- ------.- - --------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California