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FOR OFFICE USE: ----------------------------- ----------------- -------- APPLICATION FOR SANITATION PERMIT Permit No. .11f,� . a�.. ----- -------------------- ----------- -------------- (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. / L / JOB ADDRESS A C N--- =�=--�----��..IO(�.�-------��- - --• - - ------------- Owner's N_pine. __ - --------------------- Phone...............-------------__-- Address ----------_._-- -- --� ---------------------------------------------------------- Address---- --------------------------------------------------••---------------------•-- -------------.----•-----•-•---- = � "VC Contractors Name Phone.. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other �❑ Number of living units:'./.___ Number of bedrooms _ _ Number of baths j.. 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 I] Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No Q5-- FHA/VA: Yes ❑ No ❑/ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SepticrTank: .� Distance from nearest well_________________Distance from foundation-------------------Material------------------------------------------------- J1 / No. of compartments-----------------------Size-------------------------------Liquid depA---------------- ---------Capacity--•----------------f Disposal Field: Distance from nearest well-- -._Distance from foundatio __ .. ____...Distance to nearest of line. .r�-.._.... Width of trench--,A .... ®� Number of lines.- -- Length of each line__..._ ... ._ _�f._. --••-- -----••• 1 Type of filter material. _. Depth of filter material___ Total length__.-...._ __� ----- ---- �+ Seepage t: Distance to nearest well--_.�e94-Distance fr foun ativn___..> 57'D c�f,to nearest"lot Number of pits------/------------Lining material__ —Size: Diameter__._'r :=___...:Depth-- Q_____________________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining materia l-----_____.-_______--------____.----- ❑ Size: Diameter--------------------------------------Depth----------------•----------------------------------Liquid Capacity-------------------........gals. Privy: Distance from nearest well------------------------•------------------------Distance from nearest building--------.-.---------•-------------..------ ❑ Distance to nearest lot line------ ----......- ----------- ----- ii Remodeling and/or repairing (describe)----------------- • - ------------ --------------I----------------------------------•------._..-.---••-•-----------------------------------•----------•-----------------------.----------•-----------------••------------------------•-------------- i I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and r ulations of the Saq Joaquin Local Health District. Sgned --------------- --- -------- •---• ----( ontroctor) ( i ) == By:------------------------------------------------------------------------------------- -- - ------- n be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----. --------------------- ------------•------•-------------------- DATE!!4 BY------------------------------------------------------------------------------------------------------------••---------------- DATE------•----------------....-------•---------------I-------- BUILDINGPERMIT ISSUED--,...........•-----------------------------------------------1------------------------------------- DATE---------------------------------.__-------------.---------- Alterationsand/or recommendations:.-------------------- --------------------------------- ------------------•-_.---------------------------------------------------------------------------- ---------------------•---------------------..--------------------------------------------------------------------------------....-------------------------•---------------------------------------•-----......_.------ FINAL INSPECTION BY /I Date_ l�� ----------j SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South Amerltan Street 300 West Oak Strut 124 Sycamore street 205 West 91h Street Stockton,California Lod],California Manteca,California Tracy,California ES 9 REVISED e-59 2M 6-81 ATLAS