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FOR OFFICE USE:--------------------------------------------------------- k t APPLICATION FOR SANITATION PERMIT Permit: No. ------------ ------------------------------------------- (Complete in Duplicate) r - ------------------------------------------------------ --- 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.' • 0Z7-yo 2so -O JOB ADDRESS AND OC TION�4 /------ ------ ------------ ---!f W ----- �JQ--•---•------------ Owner's Name------------- -' + --- - ------•-------- - ----------------------- Phone------------------------------------ Address---------------- ----• -------•- - . -- - ------ '-------.----•- ---------------------------------------I-------------------------- rContractor's Name- -- ------------------- - ------------- ------- - ------ - ---- - ---- ------- ----- - --------- ------------ ---.-•-------- Phone----------------•-•---------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ E Number of livingunits: -/---- Number of bedrooms Number f baths _____ Lot size ______ __ ___ _____ __ _ ------------------- k Water Supply: Public system ❑ Community system [-] Private Depth t ~ater Table ....._.. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date......... . ......) No ❑ New Construction: Yes ❑ 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 nk: ' Distance from nearest well---- a__�._.Dis#ante fromfound tion_____t0_�_.____ Materi l_-_.--�f--- -_ ---------- No. of compartments.....__.7Y-_-_-----_Siz ___tf'_�__X.- '-__Liquid depth----.Y-.-_-------- ---Capacity-__ .._ �_. . DisP ieId: Distance from nearest well---5.0_-------Distance from foundation-,!!---------Distance to nearest lot Number of lines-------------1._.----------------Length of each line-----1_°.4---------------Width of trench.__-:;-__-----_-.__--_----_-_--_. Type of filter material--------- �.iZ_'_-_Depth of filter material---_._ -----._.Total length----I-11_O---------------------------- Seepage Pit: Distance to nearest well---_------------------Distance from foundation------------------- Distance to nearest lot line----------------- ElNumber of pits----------------------Lining material---------------------- Size: Diameter-------------------.-.-Depth--------------------------------------------- Cesspool: Distance from nearest well_______________-Distant y p e from foundation-------------- Lining material,____---------------------------_-- ❑ Size: Diameter---------------- ---- --- -- ----.Depth- -------------------------------------------------Liquid Capacity---------------------------gals Privy: Distance from nearest well ______----------------_--------------------------Distance from nearest build-sng-------------------------------------- 'Distance ___.________________-_-______.___`Distance to nearest lot line- ------ ------------ ----------- ----------------------------------------------------------------------------------------------------------- J Remodeling and/or repairing (descr' e ------ ---'- -- ------------------- -- ---•- --------._---- .------------------------- ..... ............. ------- ------ -- - ----- ------- --- - -. -•------- - ----- -----------------------------------------------------------------------=----------------------------------------------------------------------------------------------------------------------------------=------------------- I hereby certify that I have prepares!"tkis applicafiori and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. Si ned --- =-`-------�------------------------------ dor Contractor - ( g )--- -------- - --� / ] B ' ---- - ----------------- -- +le) -------------------------------------- - - - ------------- tom ------ pan, showing size of lot, Iota+ion of-sy +em�in-r ation +o wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- -� ------------------------------------------------- DATE---V.-_- -�7----------------------- REVIEWEDBY-----------------=----------- --------- - -------------------------------------------------------------------------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED-- ------- ---- ----------------------------------------- -=-- -------------- DATE------------------------------------------------------------- Alterations and/or recommends+ions: =--:--------------- ------ ------- --------------------- ----- =-._:.- __..........4......--=---------------- ----------------- --------------------------------------- --•----------------------------------------------------- ------- ---•----------------- -- ------- --------------------------------------------------------------------------------•------------------------------------------..--------------- --------------------------------------------------------- -------------------------------------•---------- -------------------------------•-•--- ----•------------------------•----------------------------------- --------------------------------------- -------------- - ------------- ------ - ------- - ---------------------------------------------------------------------- --------------------- ------------------------------------ FINAL INSPECTION BY:. ' --------------- Date_ �. �. .-------- ------ ------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave, 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.