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FOR OFFICE USE: ------------------------------------ / APPLICATION FC� SANITATION PERMIT Permit No. ..4_ .....:;-.-z- ------------------------------------------------- ------------------ -----------------.-------------------- (Comolefe 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 Orclinane No. 549. JOB ADDRESS AN LO ATlON' �_ _. _ ---------- Owner's Name - ---------------------•------------ ------ ---------- -------------- Phone--_------------------------ ----- Address------------------ ----r ------/r��... _... . .. Contractor's Name------------------------------•---- - ------- ---- • •-----------. Phone-------------------------------- Installation will serve: Residence � Apartme t House ❑ mmercial ❑ Trailer Court ❑ Motel ❑ Other ❑ _ y Number of living units: _1____ Number of bedrooms ______._ Number of baths ___t__ Lot size _____ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table _ ___ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeK Hardpan Previous Application Made: llf yes,dote___.....------......} NoN/a New Construction: Yes K No ❑ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) r/� _ Se49 Tank:" " ""Distance from nearest well_ ____Dis from found�a,�n___________ ______Matet'i _=__ _" __ __ ------ No. of compartments----- --------SizA X/n__�___.___Liquid/ dep;h---------'�- -- ---------Capacity-/- - Dis�osTal Field: Distance from nearest well--- Q._____Distance from fop dation___C_Q-______.Distance to nearest lot li �y_ of lines________�__________________Length of each li �_ _C4_Z).__.Width of trench._ __ ---------------------- Number.Type of filter materials"_ --:____Depth of filter material_____ _ ___`_Total length____ ____ Seepage Pit: Distance to nearest well------------------_---Distance from foundation--------------------Distance to nearest lot line_._____.______.__ A ❑ Number of pits----------------------Lining material-----.-----------------Size: Diameter--.--------------------Depth---.----------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-_______________________________- Size: Diameter--------------------------------------Deth--------- ------------------------------------------Liquid Capacity ---------- Distance from ne _------------------------------_ Distance from nearest building---_-_ _____,_ -_ ______ - ----- ❑ Distance to nearest lot line----- --- -------- -------�----- --------------•-----------------•----- --•--------- -=----------------------------------------------------- Remodeling and/or repairing (describe)=-------2 ----` '� = = �---•------------------------ -------------------------------------------------------------•------------------� ----------------•----------•------ ------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------•----•---•------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------•----------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, St law and rul s and regulations of the San Joaquin Local Health District. (Signed)- - -------------=-----------------------------------------------------------------------------(Owner and/or Contractor) B --------•-----------------------------------------------------------------------------------------------------------------------•__(Title)---------------------- -- _ {Plot plan, showing size of lof, location of system in relation to wells, buildings, etc., can be placed on reverse side} _ FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY------------------------------------------------------------------------------------------------- DATE-------------------------- --------------------------------- REVIEWED BY------------------------------------ - --- ---------------- -------------- --------------------------------- DATE---•------ . �---------•-------- BUILDINGPERMIT ISSUED-------------------------------------------- 1------------------------------ DATE--------------- -- A-4------------------- .......... and/or recommendations:----------------------------- --------- ------• ----•----------------------•------------------------------- FINAL INSPECTION BY: - ""`!�'i---- Date----------- -- --- --3�------ ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California c! ES 9 REVISED 8-59 3M 3-'63 r-P-CD. J.