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F R OFFICE USE: Y�-- ----- I APPLICATION FOR SANITATION PERMIT Permit No. ------------ (Complete in Duplicate) - ------_-------_---------------------------------- 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. I JOB ADDRESS A O.CATI N______ -: _ -- -------- -- - --- -- ------------ ----- --- ---- -- --- ----- Owner's Name------ -- --- ------- ----------- .•: - - ------------------------- ---------- Phone --------- ._ -- -- --------- �-' - f ------ Add ress------------ ,. ----- . -�- --------- --------- Contractor's Name / - ' .� P ne. �? 7- Installation will serve: Residence 50 Apartment Ouse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ � r Number of living units: __j----- Number of bedrooms -S--"Number of baths j---- Lot size -- ------------------------ Water Supply: Public system ' Community system ❑ Private ❑ Depth to Water Table (cU_c_7ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ L Previous Application Made: (If yes,date--------------------I No x New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: 1 ,r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- Distance from nearest well_________________Distance from foundation--------------------Material----_-------------------------------------------- Elkt40)& No. of compartments_---- ---------------Size-------•-------- ---------------Liquid dep�h--------------------------Capacity---------------`----- t Disposal Field: Distance from nearest well Flo/ Distance from foundation..Zd-__-____.Distance to nearest lot line__-�_---_---- (f� Number of lines__ '�----___.-_Length of each line___�Q_�_ f(_-_____._.Width of trench__�J�" �_._________"__.____ 1 r tt Type of filter matenalj_�.__��L'-.�-Depth of filter materia!_-_��____._._.__Total length."_">�'i.Q_ _________________________ r -_.___.Distance to nearest lot lin��_.__�__._ Seepage Pit: Distance to nearest wel!_yd..1It��r---Distance from oundation___ p rr Number of Its-. � .Lining material----- :.__--.-"------Size: Diameter--. .. -------Depth---.. - ------------- W Cesspool: Distance from nearest well----------______Distance from foundation.._.____.-_____--..Lining material----_____----------..______----______ ❑ ---------------=-----Liquid Capacity- --------------------------gals. Size: Diameter--I---- --- --------------------- ----Depth--------------------....v-_.- -_ Privy: Distance from nearest well--- Distance from nearest 1 /-- ' building____...__._-----_.______-_--- -------- Distanceto nearest lot line----- -- ------------ -•------------ ---------------------------------------------- --------- ---- •------------ Remodelin9 and/or repairing {desctibe):---- G --- ---------------•--------------------------------------------I------------------------------------------------------------------------------------•----------------- ! ---------------------------- ------- ------------------------------------------ ------------ -------------- ! hereby certify that I a prepared this application and that the work will be done in accordance with San Joaquin County ----------------------------- ordinances, State la , a d r es---------- ws 'rid regul Ions of the San J quin Local Health District. t-!• -- `�' - ---------------- ---(Owner and/or Contractor) (Signed}--------- --- ---------- -- ------- 3 -= r=s. -,-�----------------(Title} --- -_- ----....._BY� l(Plot plan, showing size of lot, location of system in relation buildings, etc., can be plat on reverse side). k .t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_._-' -- --- DATE------- --� --"-e" ------------------- E REVIEWED BY----------------------------- -------------------- ------------- DATE----------------------------------------------------------- --------- BUILDINGPERMIT ISSUED----------------- --------------------------------------- -------------------------- ---------•--: DATE----------------------------..------_---------------------- tAl erations and/or ecommendations--------------- ---------------------- - ----------------•------------------------- ---•-------------------•------------ ------------------------------------- ------------------------------ - -- -- -- -- ------------ _____________________________________------------ ---------_--------__ ------------------------------------------------------------------ 1 FINAL INSPECTION BY:.....-... ------------ - -------------- Date 6 / .-------- - ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.