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-- ------------FOR OFFICE USE: } ----------------------- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ... ............. --------------------------- (Complete in Duplicate) Date Issued ------ s ------------------_--_---.-__---------__._._-_------- i. This Permit Expires 11 Year From Date'Issued .. _�.. _ --------�=J�-,- �� Application is hereby made to the-San Joaquin Local Healfh District for e permit to construct and install the work herein described. t This application is made in compliance with County Ordin e No. 549, a JOB ADDRESS AN LCATI f----�-L x------C/ -------- ----------------------------- ----•--•-- ---------=-••------------------- Owner's .. -----------•----Owner's .Name__ ...... -----••--------------------------- - Phone............ ----------------- Address !?? - ------ "� '`- � ..,.-..�.� ---' - I t Contractor's Name = Phon _... Installation will serve: Residence [/part z not House ❑ Commercial ❑ Trailer Court ❑ Mote ❑ Other [] ther ❑ Number of living units:'.--t/;- Number of bedrooms xz — Number of baths _ - Lot size __ _�-- 8---`--•-- Water Supply: Public system ❑ Community system ❑ Private g?-Depthto Water Table;�,Aft. Character of soil to a depth of 3 feet: Sand ❑ Gravel'❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ER—f"ardpan ❑ Previous Application Made: (If yes,date-------- No New Construction: Yes ❑ No HA/VA: Yes E] No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspoolip permitted if public sewer.is available within 200 feet.) Septic Tank-, Distance from,;nearest welL�?�_-r___Distance from foundation---/-0_____--Mat I___ No. of compartments-- Size__ Liquid depths Capacity ----------- -- sp a Field: Distance fromnearest well___-�____-___.Distance from foundation____________________Distance to nearest lot line______-.-________ � Number'of lines-------------'.a � `a-----'---Length of each line-------•------------------=---Width,of trench-------- --------------------- Type of filter material_k_______________ ___Depth of filter material__..._________._-'.____Total length_______�_____-__._.-.-_______-_._---_- G\ . ., ► p r Seepage it: Distance to,nearest well_ -----______-_Distan ce f om f undation..;{P___ _______.Distance to nearest lot line_-.-�___._... Number of pifs----- _Liningmaterial_ -Size: Diame'ter------- °-,.__...___.Depth_. J.D_r__________________..2, Cesspool- Distance from nearest well__`'______________Distance from foundation-__-____-;_.____-- Lining material__.-----..____________.______..._ --- ----- = -Liquid Capacity----------------------------g ❑ Size: Diameter---=--�`--------------------°=--------Depth---------------- --•-� _ als.. Privy:, Distance from: nearest well-------------------_.______ Distance from nearest building_____---__---------------------- _______----------------------- i w .. ❑ Distance to nearest lot line-------------------- ------------------- - -----•---------......--------------•---------------------------------- { --- -------- --------------------------- -- .. Remodeling and/or repairing (describe)-------------------€---------------------------------------•----••-------------- ------------------------ -----------------------------•----------------------• -•----------------------------------- --------------------------------------------------------- ----------------------- -------------------------- ! I hereb Fit that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances Sta e I s, and,r s�,and reg tions of the,San Joaquin Local Health District. 4 ` R 5 -._ - -------------------------- ner and/or Contractor) (Signed) ---------------------.I.�---- ------ --------------- (� ---- - ti.. i Title-- ---------- -- -------------------- (Plot plan, showing size of lot, location of system in ation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY $� r DATE__ APPLICATION ACCEPTED,BY `1• -- ---- - '� REVIEWED BY - �----•---- - DATE-. BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- meknai and/or recommen' atians'-" - _ --------------------- �--------------- .. --------------------------------------------- ------------------------------------------------------------------------- ------ r ---------------------------------------------------------------------------------------------------------------------------- 4y e , FINAL INSPECTION BY:.-.-- - ______--_--._.__...__-.__.---------- __ Date-----.. ..__^^._ _ '"------_.._ I//__-___.__._____. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California i REVIE3E0 H-59 r.P.0 D.2m 6-6D