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r OR OFFICE USE: 1 -------------------- � 1 APPLICATION FOR SANITATION PERMIT Permit No. ._ ___.._. �. f ------------------------------------------------ -------- ---- ------- --------------------------------- -------- (Complete in Duplicate) - m 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 Coun y Ordinance No. 549. i ' ON -------------------------- JOB ADDRESS D X -- Phone---------------------------------- Address------ ---------Address------ - -------- ---------------------------------------------- -------------• ------------ Contractor's Name------ •--------------•-�•---------------_--- ---------------------------••----------•-••---- Phone- .- --- Installation will serve: ResidencefApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Ofi�+er ❑ z Number of living units: X:____ Number of bedrooms :�____ Number of baths _Z-- .Lot size /a --- --•------• Water Supply: Public system Community system ❑ Private [-] Depth to Water Table Character of soil to a depth of 3 feet: Sand E] Gravel C] San y Loam ❑ Clay Loam E] Clay E] Adobe E"Hardpan F] Previous Application Made: (If yes,date------.___,--------) No 9!r New Construction: Yes �-'No El FHA/VA:.Yes E] No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept- Tank: 4 Distance from nearest well-_______________Distance from foundation_____________'__--_.Material____________._.____________.____-- _-________. 1 No. of compartments-------------- ----------Size------------- ------Liquid depth------------ -------------Capacity--• �.._. Dispos FiN : -r Distance from nearest well___'-_-____' Distance from foundatiola>ld_______`_._--Distance to nearest lot line__..____. Number of lines.--------��----�ss_________.____Length of each kne_____ Q--------r-------- Width of trench.__ ________ Q IType of filter material____AR- S____-_--Depth of filter material__ _lI/r--" Type length-_ __ 6___________________J �, See�p}aagge Pit: Distance to nearest well_'.:-�-_-____"___Distance foundation�j_P_----------Distance to nearest.lot line _ � 1J o--J Number of pits.._._________________Lining mafenal_._-�_-. �/�-.Size: Diameter----------------_-- ---.Dept --...----------__-------- I 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__.._______-_-__________________-----_--_. n y 1 ' ❑ Distance to nearest lot line------ -------=--- ------•------------- -------------------------------------------------------- `-: t --•-----------------"-----------------------:------------------•-•--------------------------- Remodeiing and/or repairing (describe):---------------------------------------------• _ ---------------------------- -------------------------------- ----------------- ------- -------------------------------- '---- k -------------- -------------- •--------------------------------------- ' --------------------------------------------------------------------------------------------------------------------------' --- :---------------------- -.-----------__-- I Hereby certify that I have prepared this app cation nd that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulation the an/Joauin Local Health District. (Signed)------------------------------------------- -- -- - ----------------- ' . ------------------(Owner and/or Contractor) ------------ BY - -------------(Title)------------------- ---------=---------- ----------- - (Plot plan, showing size of lot, to ' n o s em in relation ls,_6ailding`s,'e+c.; `can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- ._----- ----------------------'------- - DATE....✓-z_�/J REVIEWEDBY---------------------------------------------- ------------------------------------ ----------------------------------------- DATE-- --------------------------------------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------- DATE Alteratiorus and/or recommend 'on :__.._ -------- __.__ __ _______ --------------------------------------- ---------------- ---- `�� _. __ z --------- -------•------------------------------------------------------------------- --------- ------------------------------ ------ --------------- - ------------------ -------------•-------"------------------"---- -•---------------------------- ---- --------------------- -----------•------------•--------------------•------------- ------------------------------------- 1 FINAL INSPECTION BY:----- 7` ---------------------------------- Date--- --------------- - -------------------------- --------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Art. 300 West Oak Street .12 4 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E$ 9 REVi9ED S-59 3M 3-'63 F.P.CC.