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FOR OFFICE,USE: ... APPLICATION FOR SANITATION PERMIT Permit No. ..____.�_.... ---------------------- -------------- --------------- -- (Complete in Duplicate) -------- -- ----- - -. ____-_ r This Permit Expires 1 Year From Date Issued 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. JOS ADDRESS AND LO Tl0 .2a_ _��--------------------------------------------------- ��-..3 -�7--0��r Owner's Name.' _v_____ ._I�_____...._ -- -------- --------------------------------------- ---------------- ------ ---------------- Phone------------------------------------ Address---------- _ ----------------------------------------------- Contractor's Name ------`-5��-- ----------------------------- -------------- -------------•-------- Phone-------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ________ Number of bedrooms --------- Number of baths ________ 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 ❑ Clay ❑ Adobe ❑ Hardpan ❑N Previous Application Made: (If yes,date-------- -..........) No ❑ New Construction: Yes [INo E] FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND.SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic k: ante from nearest well__________._____Distance from foundation___________________ Material--_-_______....______._____.______.___..__-____. N . of compartments--------------------F-- -----------Capacity --.Size-------- -----------------------Liquid depth-------- -- ----------------------- Dispos I Field: Distance from nearest well-----------_-----Distance from foundation--------------------Distance to nearest lot line______:____._____ Number of lines-----------------------------------Length of each line----------------------------..Width of french--------------.--------------------- Type of filter material_______________________Depth of filter material-----------------------Total length------------------------------------------ see pa it: Distance to nearest well__-,IDG-----__.____Distance from foundation__1b_------------DIstance to nearest lot line_* -...------ a Number of pits.___�L-------------Lining material aU�C____-Size: Diameter-.33__.ry..__.___Depth_,,;Z0---________.______-- 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--- ----------------------- --------- ------------------------- --------------------- -------------------------------- ------------- Remodelingand/or repairing (describe)=-- ----- ---------------------------------------•-----------------------------------------------•-------------------------------------------------------- ----------;-------------•----------------------------------------------- ------------------------------------ -------------------- ------------------------------------- ------- ---------------------------- --------------------------"--------------------------------------------------------------- -------------------------------- ------------------------------------------- ---------------- I hereby certify that I have re 'ai this application nd tat the rk will be done in accordance with San Joaquin-County ordinances, State laws, and rules an ns of the n aquin L al Health District, i -----------•----------------------- - --- --- --- (Signed) ------------ -------- --------- - --- ---------------- ------------------------------------.(Owner and/or Contractor) By:--------------------------:------------------------------------ -- ---------------------------------------------- - Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FORK DEPARTMENT USE ONLY APPLICATION ACCEPTED BY C✓--. ° — DATE 1-21 REVIEWEDBY-------------------------------------------- ----------------------------------------------------------- DATE----_----------------•---------------------------------- BUILDINGPERMIT ISSUED-------------------------------- --------------------- ----------------------------------------------- DATE---------------------------------------------------------- x Alterationsand/or recommendations:-------------------------- -------r-.-.-.--------------------------------------------------------------------------------------------------------------------- ------•---------------------------------- ---------- -------------- ----------------------------------------- -----------•----------•-------------------•-----••---•--------------------- ------------------------- ------------------ ----------------------------- ------------ ---------------- -•---------------------•------ --------•----------------------------------------------------------------------- FINAL INSPECTION BY:. -------. - Date --- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracyr California I F.F.0 C. j