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FO,OFFICE USE: v APPLICATION 4FOR SANITATION PERMIT Permit No. ----- --------------------------------------------------------- (Complefe in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit Vconstru' andjinstall the wo , herein described. This application is made in compliance with County Ord' e N 9. JOB ADDRESS AND C ION.___ _ F _ .____ ___4_______ _ _____________ ______ '-____.____ -__ _ Owner's Name - ----------------------- Phone �. Address----------- -------------------- ------ ------- --..•-- - Contractor's Na /----1 ---- ---------------------- Phone---7--v.�7..... Installation will serve: Residence ®/Apartment House ❑ C mmercial railer Court ❑ Motel ❑ Other ❑ Number of living units: -/_'- Nu er of bedrooms -Z- Number of baths I----- Lot size ...ft _�__,�,-----!_._ _r---------- ._ Water Supply: 'Public system Community system ElPrivate E] Depth to Water Table avft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ obe Hardpan ❑ Previous Application Made: (If yes,date_________ __________) No ❑ New Construction: Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se r. Distance from nearest well-------- --------Distance from foundation--------------------Material__..-___...___.._______.__--________--_______-- Dispos' No. of compartments-------------- ize---------------------------- ---Liquid depth--------------- - --------Capacity------------- __Length of each line_____ al Field: Distance from nee est well. . - stance from foundation______ __Q___-__.Distance to'nearest lot line______ yupmber of fines__ p ��____-_Width of trench____�_�L' �r-.__.__ 9 -� Type of filter materia' ' --Depth of filter material__.__1_ ____________Total lengtil---------.----------.- _- Seepage Pit: Distance to neare well Disfiance fro foundation____JQ______-Di".4, to nearest lot ine...___ figp6( Number of pits...,_______________Lining material_kD__ _ ._-_'_-.Size: Diameter__.�3��...___Depth------- _ _�___-...... Cesspool: Distance from nearest well:____-_________Distance fro foundation....................Lining material_..____....___.._.._________-_-.---. r ❑ Size: Diameter----- --------------------------------Depth---------------- ` . `--- -- --- ----- -.-.Liquid Capacity--------------- ------------gals. i Privy: Distance from nearest well------------------- ---------3_____________ I _tDistance from nearest building----------------------------------____ _.'s(f' ❑ Distance to nearest lot lire--------------------------------------------P 1 ------------------------------------------------------- -- - r � ! 0� i Remodelingand/or repairing (describe):- ---------- ---------------------------------- - ------------------•-------------------•-------------------------------------------------------- t _._______________________________.____________________.___________-___.__________ r - I i ----- ------------------_- -_________-.-___-_________-___-_______-_______________-___________________.__..__.___________e_------------_____-------------------------_-_-_..___________.__.__..__._-----__--------- _-.._ 1-hereby certify that I have:prepared this application and that th'e work wil .bei done in accordance with San Joaquin County ordinances, Stae laws and-rules an ` gulations of the San Joaquin Lo '" H If District. r (Signed) --------------------------------------------------- _ _ or Contractor] ---------------------------- �. -- -----------(Title)---------- ------ ---------'--------------.:.---------- ------ (Plot plan, showing size of of, location of system in relatio o welts, 6uildtn�js, c., can be placed on reverse side). FOR DEPARTMENT USE ONLY", APPLICATION ACCEPTED BY---- ..•---'-... `--"---------------------? ----I--------- ----------- DATE--'- . 1 REVIEWED BY---------------- ---- -'- -'----- - ----------------------------------------------r = _ ------ DATE------- -' BUILDING PERMIT ISSUED-------------------------------------- ------------------- — -'" DATE � ------ - --- ----- o ------ Alterations and/or rec --- -__- --- � ______ � ------� ------------------------------------------ -- 1 ' I -------------------------------------------------------------- ----------'---------------------------------------------------------------------------------------------------------- --- -- ---------- --------------------- FINAL INSPECTION BY:......C.-_,.... ---------------------------------- Date-------'3_'_ ..'bS- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Loeb,California Manteca,California Tracy,California