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FOR OFFICE USE: ------------------- ----------------- ---------- p� -------------- --------------------_ ----- ----------- _ APPLICATION FOR SANITATION PERMIT Permit No. az _. --- ---------------------- --- -------------------------- (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. �! JOB ADDRESS A LOCATION_ . _ -- __--- - a_��_ __ t_ _- _:------------------- Owner's Nam -- -----------•-------- , - ---- ---- ------------- Phone- ------- ---- Address -------------------------------. --- 4 -' -------Contractor's Name Phone Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/____ Number of bedrooms _---2. Number of baths >`O' Lot size __-___-____________________________________________________ Water Supply: Public system ❑ Community system ❑ PrivateDepth f Water 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__._--__ .-------J 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 Tank: Distance from nearest well----__ ---- Distance from foundation_--__1-4- Material______ ----------- ----------, No. of compartments---__ -y-------- Size-- _ __�`_T_-. Liquid depth-_-Z/---I---------------Ca pacify-_/1 G Disposa Field: Distance from nearest well---�A_'.__Distance from foundation-----d.A__±_____.Distance to nearest lot linea Number of lines_______-. _-___-n____- Length of each line----9'4'_____--�____-Width of trench.___X._�,________--_--_-____ Type of filter materia!-___- ,li..........Depth of filter material____-.�. ^� p -----------Total length--- �------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation---.--------------- Distance to nearest lot line ------------- i ❑ Number of pits------------------ Lining material--- ---------------Size: Diameter ------------------ Depth------------------------ ----�- Cesspoof: Distance from nearest well-----------------Distance from foundation----- _ ___=.Liing material--------- --------------- ------- -_:_. ❑ Size: Diameter--------- ------- ------- -----------Depth------- ------ - - -- - -----------------Liquid Capacity -----als. Privy: Distance from nearest well-----------------------------------------_------Distance from nearest building -❑ Distance to nearest lot line--------_ ------------------------------------ - - Remodeling and/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 ws, and rules and regulations of the San Joaquin Local Health District. (Sighed) ------ - -------- ------------- ------- ------ "" laer and/or Contractor) Sy:-------- --------- ----- --- ---- ------------------------------------------(Title)---------- ---------------------- - -------- (Plot plan, showing size of lot, location o system i relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY__, _CA ------------------------------------------------------ DATE- REVIEWEDBY--------------------------------------------- ------------ ------- ------------------------ --------------- DATE BUILDING PERMIT ISSUED-------------- ------ DATE--------------------- i Alterations and/or recommendations:------------------------ ------------------------•-- ----- ------------------------ - ---------- -- I---------------------- ----------------- - FINAL INSPECTION SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 O. ,