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FOR OFFICE USE: eqg . ------------------------ - — ------ APPLICATION FPR_SANITATION PERMIT Permit No. __ --------------------! -------------------------------------- ----- - (Complete in Duplicate) --- Date Issued -----------------------------------------------.--------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance N9_1549. JOB ADDRESS AND LOCA N____ d- - ---------- -r------ ---- _ Owner's Name-------- -F•�e_ --- Phone_�i� 3 S ---------------------------- Address___ --- Address--,_ e 4 - Contractor's Name_______________ _ Phone- -- - ---- -- ---- -- -- ------- -- -== - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _At-Number of bedrooms _3._ Number of baths _ -_ Lot size __ 11 __ .-/-- __._-____-__.___ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table _6�0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel-0 Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E---Pardpan ❑ Previous Application Made: (If yes,date_/1.5�1__7_1 No ❑ New Construction: Yes ❑ No Pa-'�FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: {No septic tank or cesspool permitted if public sewer is available within 200 feet.} tic nk: Distance from nearest well-------------- --Distance from foundation--------------------Material _____.-__-_____-_--_._-___._______---___.._._. No. of compartments--------------------------Size---------------------------- ---Liquid depth-----, -------------------.Capacity----------------------- Disposal Id: Distance from nearest well-Distance from foundation___—_____.._Distance to nearest lot line__;Z4______ r Number of lines----- -----------Length of each line__!;�'D______-__ __ic__-.Width of trench..__�_��_�_�J�_--_.r_ Type of filter material s_- -pG�--Depth of filter material-___� ___----___Total length----------------------1- ----------- #4 V% Seepage it: Distance to nearest we4_7_)UT4-4?--_Distanee from foundation___3_�_______.Distance to nearest lot line------ __-_-_ EErNumber of pits___.__,___________Lining materia .___ _�G _-Size: Diameter__..3_3--- Depth Cesspool: material .. , Distance from nearest well_________________Distance from foundation___.________.-___._.Lining material_...___.-____-.____-____-___.______- 9 ❑ Size: Diameter--------------------------------------Depth-------------------------------- -------------------Liquid Capacity----------------------------gals. C Privy: Distance from nearest well--------------------------------------------------Distance from nearest building-----------------------------------------. '. , ❑ Distance to nearest lot line .------ --------- - ------ -------------- Remodelingand/or repairing (describe)------ - --------------------------------------------------------------------------------------- --------------•---------------------------------------- Vr3 ----------------------------------------- • _-� ---------------------------------------------------------------------------------------------------------------------=-------------------------------------------------------------------------------------------------------- t I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, � to 41a ,, and rules and r gulations of the San oaquin Local Health District. {Signed} ----------- {O ner and/or Contractor) By:---------------------------------------------- - [Title} ---------- (Plot plan, showing size of lot, location of system in relation to wells, dings, etc., can be pla don reverse side}. FOR DEPARTMENT USE ONLY = f APPLICATION ACCEPTED BY---------- ----- f� i ------------------- DATE------------- --- --- - --------------------------- - REVIEWEDBY--------------------------------------------- --------- ----------------_------------------------------------------------- DATE-------------------------------------------------------- -- BUILDING PERMIT ISSUED--------------�------------------- ----------------------------------------------------------------- DATE Alterations and/or recommendations------------------------------ ------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------I- ------------- --- ------ ---------------------------------------------------------------------------------- ---------------•-------------- ---------------------------------------------------------------- ------- -------------------------------------------------------------------------------------------------------------•-------------------------------------- -----•------------------------------ -------------------------- ------------ ----------------------------------------------------------------------------•---------------------------- ------------------------------ ---------- ----------------- - ---------------------------------------------------------- -------- ----------- ----------------------------------------- - ------ ------------------------------------------- FINAL INSPECTION BY: ------ '°� Date---------------- ----------------e104",-------------------- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. y 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.RC O.