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FOR OFFICE USE: ----- ------- - --- - � ----------- ----------------- - _ �APPL'iCA7lON FOR SANITATION PERM Permit No. ------ -------- ------------------ --- --- ----- (Complete in'Duplicatel Date Issued This Permit Expires 1 Year From Date Issued a-5-0- 1-5-0 ^1 S� r Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descrUi . This application is made in compliance with County Ordinance No. 549. -75-oc) Fr EJ 'T7-t ST fi ,� �� ,, 0..L- LOCATION ------•-`��' -�--•-- ------------------ -------------------- JOB ADDRESS AN - C - - -- --------------- Phone If - -- Owner's Ci- ----------------------------------- Address__ Q_- ------=----- - r Phone.. i �� Contractor's Name------------------- ---- Installation will serve: Residence ❑ Apartment House ❑ Commercial V 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 ❑ Previous Application Made: (If yes, --------------- 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.) Septic Tank: Distance from nearest well_________________Distance from foundation ______ Material__..________._.___._____ .__________...___.____.. Size_ - Liquid depth----------- --------- ---Capacity-----------�--------- No. of compartments-------------------- - --------------- ff � Disposal Field: Distance from nearest well_g5.!"_Distance from foundation./4_- Distance to nearest lot kne_2__-_ _____ D Number of lines------ 9 f f - Length of each kne----------------- -.Width of trench__ __• `.�_______.____---"--•-- Type of filter matsrial_ �_%----Depth of filter material____ ___1�-.--_Total length_______SP-----------------__.___ [` Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-----.-_-_____.__ ❑ Number of pits------------------ --Lining material-----------------------Size: Diameter--------------- -------Depth--- ----------- ------ Cesspool: Distance from nearest well-----------------Distance from foundation._-_-------------- Lining material-.________-__..____._-_________-. Size: Diameter--------------------------------------Qepth--------------------------------------------- Liquid Capacity gals. Privy: Distance from nearest well-------------------------- - ------------------Distance from nearest building------------------------------------------ Distance ----. ----------------------------------Distance to nearest ]of line________________ - Remodeling and/or repairing (describe):----------- -- -- ----- ------------- ----' �f- -------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, to 1 ws, and rules d regulations of the San Joaquin Local Health District. er and/or Contract�]' - ------ --------------------- --------- --------- --------[Own d/o [Signed}------ --- --- ----- _.. or --- - ------------------------------------ ---- -- (Title) F (Plot plan, showing size of lot, locatio�' �ion to welds, buildings, etc., can be place o reverse side). e). FOR DEPARTMENT USE ONLY DATE----- APPLICATION ACCEPTED BY------------------------3---------------------------------- -- �- REVIEWEDBY---------------------------------------------------------------------------- DATE_ ----/-------------------------" ------------ ------------- BUILDINGPERMIT ISSUED---------------------------------- --------------------- --- - --------- Alterations and/or recommendations--------------------- -------- -------------------- - -- ---------------- ------- -----•----- ------------------------------ r -------------- ---------- ------------------------------------------- ----- -------- ------------ - -- ------- --- --- FINAL iNSPECTION BY---------- ----------- --- -+i Date_--------1 - ---------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.ma:elton Ave. 300 West Oak Street 124 sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.V.CC.