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FPR OFFICE USE: �� --- --- -----------/ .-A -------.-------------------------- ---------- APPLICATION FOR SANITATION PERMIT Permit No. �.` ------------ ----------------------------------- --- -- (Complete in Duplicate) Date Iss ued ---------------------------------------------------------- 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. JOB ADDRESS AND L,OCATIO�N , - -27/ ---------------------------------- - ------------------------ Owner's Name vt =-`' -----•---- %-Qt Phone`�� ` on Address-------------------------------- ' Contractor's Name-------------- U Phone --------------------- Installation will serve: Residence D----Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other p Number of living units: __f._ Number of bedrooms _cad__ Number of baths __/_ Lot sizeya_�________________________ Water Supply: Public system e--I-c-ommunity system ❑ Private ❑ Depth to Water Table�i_r� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe O'Hardpan ❑ Previous Application Made: (If yes,date--------------- _---) No ❑ New Construction: Yes ❑ No [r FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 3 Septic,Tank: Distance from nearest well-----------------Distance from foundation--------------------Material.__-------_____________..__________.._______.__. nip,,.''' No of compartments-------------------- -----Size_-----------------------------Liquid depth---------------- ---------Capacity----------------------- Disposal Field: Disfance from nearest well ___Distance from foundation.__/�_'_._.---Distance to nearest lot line-----`______ Number of lines-------/------------------------Length of each line------y4_---.-----------.Width of french-----"?`�___....._------------- Type of filter material_�_�/_ __Depth of filter material...,-_.S-----------Total length_________________-U----------------- Seepage Pit: Disfahce to nearest welC� ----Distance,from foundation---�/�a----------Distance to nearest lot line----S__--__.._ Number of pits------ -------------Lining material---_._*A�----Size: Diameter---x:�3..........__Depth---_------c ------------- Cesspool: Distance from nearest welf_______________Distance from foundation............. P ---- .Lining material---------------------------- -- -- s.... Size: Diameter--------------------- ----------------De th_---------------------- -- ----- - -----------Liquid Capacity gals. Privy: Distance4rom nearest well___----------------------------------------------Distance from nearest building---------------------------------------__ Distance to nearest lot line_______________________ _ . i Remodelingand/or repairing (describe):----------- ------------------------------------------------------------------------------ ------------------------------------------------------- ---- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- 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 andz regulations of the San Joaquin Local Health District. (Signed) ------- -- -- ------------- - --------------------------------(Owner and/or Contractorl By:--------------------_-------------------- ---------------------------(Title)-- - (Plot plan, showing size of lot, location of system in rel iio�i to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY j I APPLICATION ACCEPTED BY---- - --------- - ---------------------------------------------------------------------- DATE------ ---- REVIEWED --REVIEWED BY------ ----------------------------- -------------------------------------------------.- DATE------------------------------------------------------------ BUILDINGPERMITISSUED------------------------------------------------------------------------------------- ---------------- DATE.------------------- ---------------- ---------------------- i Altera#' ns nd/or recommendations:-----_--------__----- --- ------ --------------------------- - ------ ---- - - - �C _ ----------------------------------------------------------------------------------------------------------------------------------------------------•--•--------------------•------...------------------------------------- ---•------------------------------------------------ -•------- ------------------------------------------------------------------------------ -------------------------------------- ------------------------------------- FINAL INSPECTION BY:------ - ----------- --------------------------------- Date ' - --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodir California Manteca,California Tracy,California F.P.C n.