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FOR OFFICE USE: j APPLICATION FOR SANITATION PERMIT Permit No. - --------- -------------------------- . DO?. u S' --------------- -------- ------ ----------------- (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 the work herein described. This application is made in compliance with County Ordinance No. 549. li JOB ADDRESS AND LOCATI N------- —--Q- ---`'-.---------------- --- ----------------------------------------/----- Owner's Name-------- =--- ---- --- - --- -- --------------•-----_------- ------ ---- - ------------------------- ---------- Phone h Address---------�ve�'--- ------ ------•---- ----- ; �p f Contractor's Name -- -------- Phone -- Installation will serve: Residence [P�Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ..-. Number of bedrooms ._/... Number of baths ../-.. Lot size _.- -------- ---------------------- -w Water Supply: Public system [B--tommunity system ❑ Private ❑ Depth to Water Table y4 ft. Character of soil to a depth"of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: (If yes,date.------------------ ) No Ej--�New Construction: Yes ❑ No �FHA/VA: Yes ❑ No ❑ li TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) S ti k; Distance'from nearest well-----------------Distance from foundation_._.........------.Material-.-......-----.-...---------.--.--------------_. No. of compartments--------------------------Size----------------------------=---Liquid deRt�---------- --- - ---------Capacity----- -------------� I: Distance:: � �_ �,, Disposal Id: Distance from nearest well_LGl?K�Distance from foundation...�-_....Distance to nearest lot line.-.-5.__.... �r ❑� Number,,of line!-------- Length of each line----- - ---------------Width of trends-------- --------------- Type of,`filter material /_-_ 13G_ _...:Depth of filter material---.�-�-------Total length---_-- Q---------------------- k Seepage Pit: Distance to nearest well Distan foundation-- 3-S---__---.Distance to nearest lot line �----- [ � Number'.of pits......--_--------Lining material_- __ d-4/_f.' ,-.Size: Diameter-- J�-_-_-_.....-Depth__p2. ..............._. 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---------- ---------------------- - 0 -------------------------------------------------------------- ------------------------------------------ Ff If Remodeling and/or repairing (describe}------------------- ------------------------------------------------------------------------------------------------------------------- i. -------------------------------------------- ------------------------------- -------------------------•-.------------------------ ------------------------------------------------------------------------------ ---- -------------------------- ----- ----------------------------------------------------------------------------------------------------------------------------------------------------------------- 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, an&rules and regulations of the San Joaquin Local Health District. (Signed)---- ------------------------------------------ (Owner an Contractor) and/or C or B :y ----------t/--- 2 --------------- -------------------- (Title r- } (Plot plan, showing size of lot, location of system in rel ion to wells, buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------- --------------- ---------------------------------------------- DATE �� Z REVIEWEDBY------------- -- ----------------------------- -------------------------------------------- DATE------------------------------------------- --------------.. BUILDING PERMIT ISSUED,----------------------------------------------------- ---- ------------------ -- DATE------------------------------------------------------------- Alterations and/or recommendations:-../__Z. �'------- -C? �--G: --------------- -----------------------•------------------------------- 1 .i -------• --------------------- ----------------------------------------------------- ------------------ - -------------------------- ----------------------------- �I ---------------------- ------------------ FINAL INSPECTION BY-- -=---- --------------- --- -- f�Z _ 6 -- Date-------- ----- ------ ----- - - ------------------------- -------.. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:eiton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California i� Lodi,California Manteca,California Tracy, California j F.PX4. P l: