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FOR OFFICE USE: APPLICATION FOR- SANITATION PERMIT Permit No. ._-----a----_`--- � --------------------------------------------------------- -- ---------------------- ------------- ----- (Complete in Duplicate)"- Date Issued -------------- This Permit Expires 1 Year From 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. r JOB ADDRESS AND LOCATIO _ i tom' r _ - f Q ------------ --- i -- -------------------------- Owner's Name---- ' Phone Address -------------------•----------------------••------------ G Contractor's Name Phone----------------------------------- ontractor's will serve: Residence ®--'A-partment House ❑ Commercial ❑ Trailer Court ❑ //Motel ❑ Other ❑ Number of living units: _�.___- Number of bedrooms __S__ Number of baths/----- Lot size ---- """"" 1--------------- ----------------- Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to ter Table to ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ San Loam Clay Loam ❑ Clay ❑ Adob6-0 - Hardpan ❑ Previous Application Made: (If yes,date-------- "-- ) No New Construction: Yes P"No 0 FHA/VA: Yes �o ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if publicseweris available within 200 fee ) _ ei `� Septic T k: Distance from nearest well_tS -------Distance from foundation-_�_`_".--________-Material.._____._.__-_____________________________"__. No. of compartments....-��-----------------Size------U ---n'. - l squid depth--------'`----------__--Capacity---,C�-4 d----- r � � Disposal Distance from nearest well--(O- __ Distance from foundation---__d_____.._.Distance to nearest lot line___ ____________ Number of lines______ g �,.__---------------------Leng+ of each cine----- -------- ------.Width of trench.------- --�-�--- ---------------- Type of filter materiair1d.(i -_.___Depth of filter material---/� _ _ -_---- --Total length------1-e----------------- ----- Seepage Pit: Distance to nearest well--------------_-------Distance from foundation------------------- Distance to nearest lot line----------------- El Number of pits---------- --- ---Lining material-----.--------.------..Sae: Diameter----__--------.-!_-----Depth_-.------------------------------ Cesspool: Distance from nearest well-----------------Distance from foundation.-_ .-------------Lining material__-__________-----.----------------- . ❑ Size: Diameter- ------------------- ------ --------Depth---------------------------- ---------------------Liquid Capacity- --------------------------gals. Privy: Distance from nearest well-----.---------------------------------------- --Distance from nearest building ----- -------------------------- - ❑ Distance to nearest lot line-- --- ------------------- - ---------------- -- ----------------------------------------------- ------------------------------ -------------- Remodelingand/or repairing {describe-------------- ----------- ---------------------•--------------------------...---------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------ -------------•------------------------------------------- ---------------------------------------------------- --------------------------------------•------------------------------------------------------------------------------ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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, andr and regulations of the San Joaquin Local Health District. (Signed)---------------------- - .... . ........................................................... --------- . ------------------ ------------. -- .(Owner and/or Contractor) -------(Title)--------------------- ---------------- --- ....... (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY- ----------------"- -- -------------------- ---- ----------- -- DATE---- - �-� --- --------------------------- REVIEWEDBY-------------------------------------------------------- ---------------------- ----------- --------------------------- ------ DATE------------------------------------------------------------ BUI LD I NG PERMIT ISSUED-- ----- ----------------------- ----------- ------ -- - DATE----------------------- ---------- - ------------------ Alterations and/or recommendations:_-? Z ' 7----- "'`�* 4 ' i- ----- le --- �' r s. 'e- P�dot � ------------------------ ---------f----- -- -�--------�------------•------------------------------------------"----------- --- - ----- ---•--6A!� --------- -- - ---------- -t-- (.�, ►- V�' � -------- ----------- ---------------------- ------------- Date --- -- -- INSPECTION BY:. -----•-------------- Date 1--'Z-------- -------------------- FINAL 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 F.P.0 O.