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FOR OFFICE-JJSET'.`- ------- -------------- ------------- ---- --------- APPLICATION FOR .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 Healfh District for a permit to constr ct an,401rstall the work herein described. { This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND TI g� ------------------------------------------------------ _'LOC f' Owner's Name-:--- - - ----------- Phone-•----------•----------------------- c • �j ... . Address �a 2 Contractor's Name •d �`} P ------•------ ----------------------------------------- Phone----------------------------------- Installation will serve: Residence 2( 'Apartment House 0 Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1__ Number of bedrooms -.!-- Number baths __ Lot size __...____________.___ _____________________________ Water Supply: Public system C] Community system E] _Private epth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam P31.1clay Loam ❑ Clay ❑ Adobe❑ Hardpain Previous Application Made: {If yes,date---.____-_,--------} No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ NTYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Distance from nearest well___ ; /___Distance from foundation__-Id-`-_.-.__.Material........ ....._ _______. ___...._.___ 4 No. of compartments__--___�-------------Size_#'4�_,q_�1S_ __Liquid depth---- __ .____.- Capacity___ G Dispos Field: Distance from nearest well____.F ".._Distance from foundation...Zf__1-------Distance to nearest lot line_�_'o---------- Number of lines_________�--------------------Length of each line.19.4_�_%d _SO.'.Width of trench.....X I_____________________ Type of filter material- Depth of filter material-----/_,°...........Total length-____�__4_______________________c Seepage Pit: Distance to nearest well_ __________________Distance from foundation-------------------.Distance to nearest lot line-_.-_"_-__-___..- ❑ 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 to nearest lot line------- ----'-------- Remodeling and/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 and regulations of the San Joaquin Local Health District. (Signed}---------------- ----- o_ �_- - -- ,,r( er rird/or Contractor) - ----- --- ------------------ ---------------------------------------------------- ...... --•-------- --- �'-------- G�- s - - -------------------------------------------(Title)------ --------------------------------- -- - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---- .- ------ ---------------------------------------------- DATE--- '- ----------------- REVIEWEDBY--------------------------------------------- ----------------------------------------- -------------------------------------- DATE----------------- ----------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------ ----------------• DATE------------------------------ ------ ---------------------- Alterations ----------- - - Alterationsand/or recommendations:--------------------------- ---------------------------•-••------------------------------------------------------------- -----------------------•------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ----------------- ------------------------------------------- -------------------------------------------------------------------•-- -------------------------------------•--------------- ---------------------------------------------- f Date.. ._--2 � � F FINAL INSPECTION BY s^ s' • --- - -=-------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 20-S West 9Th Street Stockton,California Lodi, California Manteca,California Tracy,California ES 9 REVISED 8-59 31A 3-'63 F.p.CD.