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FOR OFFICE USE: --------------------------------------------------------- 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 Health District for a permit to construct and install t work herein described. This application is made in compliance with County�Ua,- ance No. 549. ZIF JOB ADDRESS AND OCATION_____ _ _ ____ ---- 7y�__----- c.---- ----------------------- - Owner's Name-- - --- ------ Phone----------------------- ----- -• - •--• - -- -- -- ---•-- ---------------------------------- -- --- ----- ----- - ...------------ Address------••-- ----- � ----------- - -------- -- --" -------•-- ------- + `/� ry Contractor's Name----- ---- -- ------- - - ---------•----- -------------- Phone__+T. .' d_ . Installation will serve: Residence �partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/-. Nu -----------------------ber 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 ardpan ❑ Previous Application Made: (If yes,date._______._.__..____) No ❑ New Construction: Yes ❑ NoHA/VA: Yes ❑ No ❑ TYPE OFMINSTALLATION AND SPECIFICATIONS: •" (No septic tank or cesspool permitted if pu)tic sewer is available within 200 fee . Septic Tank: Distance from nearest well _ _l/ Distance fr lfou �on__�____._____-Material---_ ..-- ------ No. of compartments__ _.._____. ______.__Sizelv__XY--��iquid depth__4�-_-_----___Capacity-_JO�__/ el Disposal Field: Distance from nearest well-__ .q `-'f�istance from foundati n _ �_ tante to nearest lot line_____sa�_._____ Number of lines------ �� Length of each line__ ___ idth of trench.__. __________________ Type of filter materials ____Depth of filter material----`f'%.__----Total length_______�L1____*__------------`._ O.P.- Seep e lit, Distance to nearest well/.-- -______Distance om undation___`_-i�..-- gr�to nearest lot iine____J _.._ Number of its._._ Linin material_,<P. . Size: Diamet� P � -- -- - -- g -- - -- - -------Depth -��---------------- Ce 1: Distance from nearest well_-----------------Distance fro foundation____----------------Lining material___-..__________.__.____.______._____ ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity- ----------- --------------gals._.gals. Privy: Distance from nearest well ...............______-______ __Distance from nearest building ❑ Distance to nearest lot line------ -- -------------------------------------------- - --------- ------------------------- ---------------------------------------- 00 Remodeling and/or repairing {descril3e}: -1___.__________ _ ____________________ __ __ ___ ___ __ _ __ _ ----------- - -- -- - - --- ----''-`--- -------------------------------------------------------------------- 1 [ ------------------------------- ------------------------------ ------------------------ -------- ---- I hereby r ' that I 4vere red this applica ' and that the work will be don i accordance with San Joaquin County ordinances, s, an and ulatio s of he S J aquin L a Health Dis ict t w Cflt�---. ( Contractorl (Signed)--------------------------- By:-------•----------------------------------------'=----------------------------------------- - ---- ------- - - ----- ------------------------------------------------------------ (Plot plan, showing size of lot, location.of system in relation t ells, buildings, etc can be placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED $Y__ .. o____ _ _ __________ ,_._-___- -____ ------------------------------------------------ DATE Y:C2^�g` CV---------------------------- REVIEWEDBY------------------------ -------------------------------------------------------------- -------------------------------------- DATE-------------------•----------------------------- kBUILDING PERMIT ISSUED----------------- - ------------------------------------------------------------•--------------------- DATE--------- -------- ------------------------ -------------- Alterationsand/or recommendations:----------------------------- - ------ --- --- ----------•---------------------- ---------------- -•--•------------------------•-----------•-----•-•----------- _--•-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------- FINALINSPECTION BY--- -------------------------------------------- ------ -- Date. ----- -------------------- ------------------------------------------------- SAN -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 4 Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC. 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