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FOR OFFICE USE: -- --------------- ------------------- -- ---------------- -- - APPLICATION FOR SANITATION PERMIT Permit No. ._, -/7.. � ------------- ---------------------- --- --------------- (Complete in Duplicate) Date Issued --- ----------------------------------------------------- This Permit Expires 1 Year From 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- (:;�i . , JOS ADDRESS AN LO ATIO _--- -- O� �� ir` Owner's Name --- e ) Phone------------------------•--•-------- Address---------- - - ---------- ----- ---- -- ----- Contractor's Name---- ----- ------- -------- --- -------------•---------------------------------- Phone__------------------------•-------- Installation will serve: Residence 93" Ap tment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other ❑ Number of living units: __l_-_ Number of bedrooms _7- Number of baths J____ Lot size ---------------------- ---- Water Supply: Public system ❑ Community system ❑ Private;�eptht Water Table -------- ft_ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan Previous Application Made: (lfyes,date-----------,_---__.-) No F1New Construction: Yes E] No E] FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Septic Tank: Distance from nearest well-----------------Distance from foundation_..-----------------Material--------------------------------------------_--_- [I r No. of compartments--------------------------Size----------------------------:-.Liquid depth------------- ------------Capacity---------------� r Disposal eld: Distance from nearest well-_�Q.-___-_Distance from foundation-----!_h-_/.__--_-Distance to nearest lot line---_____s _________ Number of lines------------ _ ---Length of each line------ _ _ ___`------Width of trench._. __..__ ------------------ - Depth of filter material____-__,j_9--------_Total length-------- Type of filter matenal----._5_., -__Dep _ Seepage Pit: Distance to nearest well_----------- _-------Distance from foundation--------------------Distance to nearest lot line-___-.___-____-_ r ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-_---------------------------- Cesspool: Distance from nearest well-----------------Distance -from foundation---.------ ---------Lining material---------- -----.._.______-________ , ❑ Size: Diameter--------------------- --------------- Depth-.----------------------------------- - ------------Liquid Capacity---------------------------gals. Privy: Distance from nearest well-------_----------__-------------------------....Distance from nearest building------------------------------------------- Distance ________-__--_---- _____--___-___----- Distance to nearest lot line------------------------------ ---------------------------------------------------------------- - ------------------------------------------- Remodeling and/or repairing (describe)----- ---------- --- --- f -------- --- ----------------------------------------------------------------- ___ __:: X-- :__ :__� _ ---- -- ------------ ----------- �--- ------------ --- _ j -------------------------- I hereby certify that I have prepared 4his application and that the work will be done in accordance with San Joaquin County ordinances, St to laws, and rules and regulations of the San Joaquin Local Health District. (Signed)--------- =s — ---------------------- ---- ------------------ and/or Contractor) B : --- -- -- - _ ----- ------- --------------- -----_=~_.'------------ - --------{Title)= ",. „x ---- (Plot plan, showing size of lot, location of s stem in lation totwells, buildings, etc., can be placed on reverse side). I FOR DEPARTMENT USE ONLY - APPLICATION ACCEPTED BY - - - .1P.>/_/+ ---------it-------- - --------------------------- DATE---"/--- ------------------ --------- REVIEWEDBY---- ----------------------------------- ------------------------------------ ---------------------------------------------- DATE.------------- --------------------------------------------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------- ------------- DATE---------------------- ------------------------------------- Alterationsand/or recommendations---------- --------------------------- ---------------------------------------------------------•--------------------------------------------------------------- --------------------------;-----------------------•-------•---------------- - ------------------------------------------------------1--------------------------•--------------------------- -----------•------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------- ----------- --------- ---------------------------•------------------------------- ---------------------------- ----------------------------------------------------------- -------------------- FINAL INSPECTION SY:. t!. ------------------- Date--- --------------------7-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,Califarnia Lodi,California Manteca,California Tracy,California F.P.CO.