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FOR OFFICE USE: -- --------------- ---------------------- APPLICATION FOR SANITATION PERMIT Permit No. _Lr , --------------------------------------------------------- (Complete in Duplicate) _._....................................................... This Permit Expires 1 Year From Date Issued Date Issued i 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. CcS~ (q19 -02 JOB ADDRESS ANDLOCATION. I ---------------- Owner's Name--, Phone--------------------- ---- ------ --------- ---- °- -------------------------------- ...... ---- f ... `� --- y ...- ------- ------------------------------------------ Address , Contractor's Name---- ------ ' - --- ---- --- ------------------- Phone----------------------------------- Installafion will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----/__ Number of bedrooms -�-_- Number f baths Lot size ---L�La e4 ._._____________________________ Water-Supply: Public system ❑ Community system ❑ PrivateDepth to 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------------ No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes.❑� No ❑ _- __ TYPE OF INSTALLATION AND S?ECIF€CATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septi ank: Distance from nearest well __.✓�©.r__._Distance from ' Distance ° foundation.____/ '_�_._..Material.___ �--------�-----�-'--- -- citYNo. of compartments. - v-- .Liquid depth ---r{ -Capa Disposa Fi 1d. D s a ce from earestw II------ -4-�._Distance from foundation---11...........Distance to nearest lot s -..- INumber of lines.-------3__.-.-._. Length of each line-----------6.7-`_--«_.___Total length Width of trench.---_..a- Type of filter material----------- ._ -------Depth of filter material------/_y._ g th___.._. ____________________ I �1 _ S Seepa it: Distance to nearest well....__�`t?__._.-----Distance fromfoundation_ l ----/,0-- to nearest lot line_________________ t {Number of pits------- ----------Lining material------Vr IISd_s. __Size: Diameter---Je_ti---- ----Depth--..--`-- '5------------------- � •,.,_,ae4: Distance from neprest weld----to.4.....Distance from foundation__JQ_'f--_--- Lining material--. ------------------------ Size: ---------------"__..Size: D4we# ,Z7.1d r---- ................Depth_`A----------------------------------------------Lzs l Capacity---------------------- --- • Privy: Distance from nearest Well ___________________--------.--------.____......Distance from nearest building-------._"--"___--".---__.---._----.----. ❑ Distance to nearest Int line---------------------------------------------------------------- ---------------------------------------------------------------------- I x Remodeling and/or repairing (describe):----------------------------------------------------------------------------------------------------------------------------- ---------------------------- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- r wit I hereby certify that I have prepared this application and that the work will be done in accordance h San Joaquin County ordinances, Sta aw , and rules and regulations of the San Joaquin Local Health District. - r — . ._... _ ------ -------(.(??aeP.and/or Contractor)�� y By:-- ------------------------ -- ----- -------------------------------------------- --- ---- -----(Title)----------------------------------------- - --- ._ (Plot plan, showing size of lot, location of Sys em in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY --------------------------------------- DATE - REVIEWEDBY--------------------------------------------- -------------------------------------------------------------------------------- DATE----------------- ------------------------------- BUILDING PERMIT ISSUED------------- --------------------- ------- --------------------------------------------------------- DATE----------------- Alterations and/or recommendations:----------------- - ---------- ----------------------------------------- ------------ --------------------------------------------------__....... ------------------------------------------------ ------------ --- ------------------ ----------------------------------- ----------------------------" ------------ ---- --------------------------------- ---------------------------- ------- FINAL INSPECTION BY j BY: . �Date --- --------------------------------------- -----•---- 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.