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FOR OFFICE USE: f � -------- ------ ---------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..:_---- ------- --_--- (Complete in Duplicate) Date Issued -7-r ------------- - This Permit Expires 1 Year From Date Issue Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This applicatio^ :r . P,. ' rnm^li.ance w County Ordinance No. 549. JOB ADDRESS AND LOCATION --- ------------- -------�---�---�------- ----- ,�r -i-- -------------- --- - ---------•---------•------------- Pho ------------•-------•- Owner's Name.-___- x'17------------- - ---•----------------•------------- ------------------- Address �- ► � •'��6-------- -A- e "�� iO --- Phone----------------------------------- Contractor's Name------------ ----------------- ------ --- ---- ---- Installation will serve: Residence ❑ Apartment House F1 Commercial e-ITrailer Court [IMotel [I Other ❑ ------- Number of living units: -------- Number of bedrooms -------- Number of baths __, _ Lot size __ -- ------------------------------- Water Supply: Public system ❑ Community system ❑ Private Pj'-Gepth to Water Table IQ- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe ❑ Hardpl�an El E Previous Application Made: (if yes,date_______________- 1 No New Construction: Yes E] No [ FHA/VA. s ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.)_% Septi Tank: Distance from nearest well_________________Distance from foundation__-_________._.__..Material-________._.___-__ __.______________.__________. 7 - ---Capacity----------------------- No. --------- ------------ No. of compartments------------- ------------Size_ -----•----------------- --- Liquid de th--------- -=--------p ` � 1 Distance from nearest well._---_.-Distance from foundation_ -----------Distance to nearest lot line__3 Disp I � i ..• Number of lines____-_ `�._.- .____---- -----Length of each line_--7�-- -----------------Width of trench Type of filter material_ L --------Depth of filter material_�.�_ _.._-�.---Total length----ASI—____-__�________________ _ x L5--' + Seepage Pit: Distance to nearest well._10a------------Distance from foundation__r 4____:_---.Distance to nearest lot hne_________________ Number of pits.----t--------------Lining material Za-c_A[-----.Size: Qiameter __'jf x-w-J- --Dept'h__... . .------------------• - Cess: Distance from nearest well----------------- from foundation--------------------Lining material------------------------------------- I ______-Li Liquid Capacity gals. ❑ Size: Diameter---- -------------------------------==Depth--------- q P Y _ __ - "" - _Distance from nearest building.___..___._____-------------- -----. Privy: Distance from nearest well------------------------------------------- �. ❑ Distance to nearest lot line--------------------- - ---------- ------- -------------------------------------------------------------------------------------------------- -- - Remodeling and/or repairing (describe):--_--=----------------------------------------------------------------------------------------- --------------- ------------------------------- y� ----------------------------------------------------------------- ----------- ----------I-------------------------------------------------------- ------ ---------------------------------------------- .------ - -- ---- -------- ---.-------- o..._ .._ ---------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin un y --------------------------------- 3 ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ---- --- --- - ______ _ ______ _____________________{Owner and/or Contractor) (Signed) - ------ ------------------------------------- Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY----- --- -------- --------------------------------- DATE------------------------------------------------------------ F ___ _ -..___. REVIEWED BY --------------------------------------- DATE-------------------- . � BUILDING PERMIT ISSUED------------------------- ----- ---------------------------------------- ------ ' �DA•TE__- -�== - Alterations and/or recommendations__________________________________________ ___ ' '- �- Z =4--------------------------------------------------------- ' ------------------ -: Date_ 7 -- 3 `= FINAL INSPECTION BY----- ------ --------- -- ------------- - --- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha=elfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California r.P.c o.