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. .... .. .. ....._ / FOR OFFICE USE: f (54_G ----- 5- --------------------------- - .___.______. APPLICATION FOR SANITATION PERMIT Permit No. ---------------------------------------------------- (Complete in Duplicate) ------------- This Permit Expires 1 Year From Date Issued Date Issued/-1D-4 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--1-7 f -!_dr�r ) - ---•--------------------- Owner's Name_. f ---------------------------------------------------- --- -- Phone------------------------------------ Address ------ ��_� Contractor's Name----C ------ --T�---------_-- - ------------------------------------------------------------------------- ------------ Phone-----•-•---------- •------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---t--- Number of bedrooms _k._ Number of baths 1----- Lot size --------------------------------- Water --------------------------- -Water Supply: Public system ❑ Community system ❑ Private �epth to Water Table 3q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe El Hardpan ❑ Previous Application Made: (If yes,date____________ _ ____I No [ New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No [!T-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t `` Septic Tandy: Distance from nearest well_________________Distance from foundation--------------------Material--____._-_..__________-_________-..__._-______. i f RPk,.�i1`-,1� No. of compartments--------------------- ----Size--------------------------------Liquid depth_-------------------------Capacity----------------------- I Dispos I Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line--_____._.__-__ Number of lines-----------------------------------Length of each line-----------------------------.Width of french------------------------------------ Type of filter materiaf-------------------------Depth of filter material-----------------------Total length------------------------------------------ Seepage Pit: Distance to nearest well-400."..........Distance from foundation___'*--------Distance to nearest lot line_.`._,_._-_ J Number of pits--. _ _ _R �C ._______ __ __Lining materialp ____--Size: Diameter__' - - ��-Depth 'd'`� f a ��___.._ Cesspool: Distance from nearest well-----------------Distance from foundation---____-------------Lining material__.-.-----------------------------._. J ❑ Size: Diameter------ -------------------------------Depth------ ---------------------------- --------------- Liquid Capacity----------------------------gals. Privy: Distance from nearest well---------------_----------- -------..------------Distance from nearest building----------------._.__._______________.._. ❑ Distance to nearest lot line-- -------------------- --------------------- - ---------------------- Remodeling and/or repairing (describe):------- ---_____________________._ S I - ••--------------------•-------------•-----------------------•-------------------------------------------------------------------------------------------------------------------------------------------------------------- -- ----------•---------------------------------•-----------------•------------•---------------------------- - -------------------------------- ------------------ --------- --------------------------- ---------------••------------------------ -------------------------------------------------- 3 I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I s, and rules and regulations of the San Joaquin Local Health District. I .. (Signed)____________ --------------------------------------(Owner and/or Contractor) By:------------------------------------------------------------------ ------------------------------------------------------------ ----(rtle)---------------------- ----------------------------------------- f (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 j APPLICATION ACCEPTED BY- �.• ------ -------------- DAT E-----,--[-i-O_ b - , REVIEWEDBY------------------------------------- ---------------------------- ----------------------------------------------------------- DATE BUILDING PERMIT ISSUED-------------------------------- ------------------------------- ------------------------------------_ DATE - Alterations and/or recommendations--------------- ------- ------- ----------------------•------------------------------------•----•-------------------------------..._ -------------------------------------------------------------------------- ----------- ----------------------------------------------------- - ---------------------- ------------------------------------------------------ FINAL INSPECTION BY: ---------------- ------- Date------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Mantecar California Tracy,California F.P.c;O.