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FOR OFFICE USE: �C. Permit No. .�.-��.......! APPLICATION FOR SANITATION PERMIT ------------------ -------- ---------------------------- ---------------- ---------------- (Complete in Duplicate) Date Issued : --------------- "- . —This Permit Expires 1 Year From Date Issued 7 Application is hereby made to the San Joaquin Local Healfh 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 AN LOCATION --- ---- ------------- Owner's NameI -- ------ Phone------------------------------------ Address---- $ �••---- - - i ----------------------------------- . -----------------------------•--- ...• ------ < Phone ------•--------------------------- ------------------------------------ ------Contractor's Name. r Installation will serve: Residence Rj- Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms .-2 Number of baths -,(--_: Lot size ----•--• Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table 4_0_7ft. Character of soil to a depth of 3 feet: :Sand [I Gravel E] Sandy Loam ElClay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (if yes,date----;------------ -:- ) No ❑ New Construction: Yes E] No C] FHA/VA: Yes ❑ No [I TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic.tank or cesspool permitted if sewer is available within 200 feet.) Septi Tarrk: Distance";from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------- No. of compartments-------- ----------------Size----•-- = -• Liquid c�eP.th Capacity Disposal Fiel Distance from nearest well.�t.`-_(__.Distance from foundation" ge2," _....Distance to nearest lot [�. Number of lines------t-----------t---------------Length of each-line----•-------------------------Width of trench___:��Y------------------------ Type of filter material,- _ -""__-Depth of filter material_"-_"� Total length-.--""" °---:-._-" ------------------ Seepag Pit: Distance to nearest well".yrOw---------_Distance from f`oundation_f_a ..Distance to nearest lot line-" ___-_"_"_. p, Number of pits_------I_-----------Lining material""" 'LSize: Diameter"""", ... Depth-"."__-._e?r+�7--------------- ��1 Cesspool: Distance from nearest well_"""-"" ,-----Distance from foundation--------------------Lining material .--------_._----_.------------------ . ---Li Liquid Capacity_ als. ❑ Size: Diameter-------• ---------------------------.Depth----• -- -------------- -------------------------- q P tY----------•-•-----------•..9 ` n Privy: Distance)from nearest well------------------------ -------------Distance from nearest building.____.".""_"_-_"""_.--------------- --- \] Distance to nearest lot line-------------------------------------- ----- Remodeling and/or repairing (describe)------------------ --- ---""------ -----------------------------•------..------ ---------- ------------------------------ I ------------------------------------------------•------- -•---- I hereby certify that I have prepared this'applicat'on and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations a San Joaquin Local Health District. (Signed)-------------- -----_---------------------- ----- - ------(Owner and/or Contractor) --------------------- --------------------------------- " ! - ----------------------- ------------------------•------------------(Tit) ------------------------------------ (Plot plan, showing size of lot, location o system in relation ,o wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY �q r f APPLICATION ACCEPTED BY--------s �` ----------- DATE----- }--�-.�--1-'� �" r-------------------- --- - --- -- ----------------------------- REVIEINED BY_ -------------- DATE---------------------..._..------ ----------------•------- f --------- ------ - --"-----•------------------------------------------------------ } BUILDING PERMIT ISSUED------•--------•------ k ------------------------•--- DATE - - - ------------- Alterffatio s and/or recommendations:-=------------------ -----•----••--••----'-------"---------- ---------------------- } I�/...... ----------- = •-- -•-•---- '+ ---------------------------------------------------------------- FINAL INSPECTION BY---- ............ ------ Date-------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 3o0 Well Oak Street 124 Sycamore Street 205 West 9Th street Stockton,California Lodi,California Manteca,California Tracy,California 1 Ee•9 RLVI9E0 9.59 F.P.CO,SM 6.60