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OR OFFICE USE: / - -------------------------11 � _47 ------- -----------___________ _. APPLICATION FOR SANITATION PERMIT Permit No. --------- ------ -------- -`------ -------- (Complete in Duplicate) r_ t- This Permit Expires 1 Year From Date Issued Date Issued ---- ----- Applicatioli is-liere-by 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--_ ._. ______________ -----------------------••-------------------•------------ Owners Name- - -----•------------- --------------------------------- - ------------ -- ----------- ---------- Phone_-------___-------------------- Address---1—K-- ..-•------------- Contractor's Name------. �� ----------------------- -------------------- ---------------------- --------• ------ ------ Phone----------------------------------- y f . - - Installation will seI ive: Residence Apartment House ❑ Commercial ElTrailer Court ElMotel 11Other p I Number of.living units: I-._- Number of bedrooms cP-__ Number of baths _---- Lot size ____L __X..� ��__________________________ Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table _4.9 ft- Character of Soilxto a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe (Hardpan ❑ TL Previous Application Made: (If yes,date--------------------) No New Construction: Yes DT'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 Ta k: Distance from nearest well---- --------Distance from foundation_zB__--..._-_-.Material-_--`------.------------------------------------- No. of compartments---r�2—----------------Size---,3_jXs`X._7------Liquid depth-------.._ P Y- Cha Ca aufi Disposal Field: Distance from nearest well-'---_____Distance from foundation--- U------------Distance to nearest lot line-._'_ _•----- �r It Number of lines-------1--------------------------Length of each line-----9Q-- ------.Width of trench-.�_I01 •----------------- Type of filter material__ tV_-.k____-Depth of filter material--&--`------------Total length-------9a-'----------------___-_._ Seepage Pit: Distance to nearest well________ -------------Distance f rr��.Qundation--_AQ_...__._-.Distance to nearest lot line_L�_,___- ❑� Number of pits----/___---_________Lining material_.{��_�ize: Diameter--_3J.__-------_Depth_r"_-____--._____--_-..- Cesspool: Distance from nearest well-----------------Distance from_fountnation--------------------Lining material ---._-___.-._______-_____-_.-------. ❑ Size: Diameter-------------------------------- --Depth---------------------------------------------------Liquid Capacity----------------------------gals, Privy: ; Distance from nearest well-----__---------- -------- ---------------------Distance from nearest building__________________________________________ ❑ r Distance to nearest lot line - --- -- ----------------------------------- -----------------------------------------------------------r------- Remodeling and/or repairing (describe):------- -- -----------------=-------- -------------------------- ----------•-------------------------------------------------------------------------•--- -----------------------------=--------•--------------------------•----------------------------------------•---•---------------------••-------------------------------- ------------------------------------------------ ------ -----------------------------------------------------------------------------------------------•------------------------------------------------•--•----------------------------------------------------- ----------------- 1 I hereby certify that I have prepa'recl this application and that the work will be done in accordance with San Joaquin County ordinance$, State I 's, nd ruI s a d reg lations of the San Joaquin Local Health District. (Signed)-- - ----- ------------------------ --:--------- ------------ I---- - --- ---------------------------- ------------------- ------------r------ -(Owner and/or Contractor) 6 :._.. ------------ - -- Title Y i { ) (Plot plan, showing size of lot, location'of system in relation to wells, buildings, etc., can :be placed on reverse side). e FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- --- ----------------------------- DATE------/z- acs"�s� REVIEWEDBY----i---------------------------------------- ----------------------------- ----------------- -------------------------------- DATE------------------------------ ---------------------------- BUILDINGPERMIT ISSUED-------- ---------------------------------------------•-- ------------------------------------- DATE----------------------- ---- ----- ------------------------- Alterations and/or rec mmendations------- ------------------------------------------- ----------------- - ------------------------------------------------------------------- (Z, = � O •------------------------ --- ----------------- -------------------------------- ----------- ------ -----•----------------- '� ., _"Sk 9 --� G/1�" 1--�r"`o. ------------ --------- ---------------------------- -------------- -----------------------------------------------------------------------------------------------------------------:----------------------- ------- --------------- ------------------------------------- . 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 j it