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FOR OFFICE USE: --------------------�1. _. --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------- -1----------- (Complete in Duplicate) Y 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 Ord ce No. 549,. Q / JOS ADDRESS AD LOCATION... -- _. �� 6-�-/ - Owner's Name-e-__' -W------------ ---- Phone -- ---------- -- -- Address_.---------- ------- Contractor's Name..____._ 3 ?S _ Phone---------------------- Installation will serve: Residence El"`A partment House ❑ Commercial ❑ Trailer Court ❑ )Motel ❑ Other ❑ Number of living units: --.1- Number of bedrooms --,3- Number of baths _/----- Lot size __-/ d.-�' 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: Ilf yes,date-------- ----- ---1 No A--�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.) Septi �k:: laistance from nearest well- Distance from foundation--------------------Material-----------------------------------------•-.---- iNo. of compartments--------------------------Size--------------------------------Liquid depth-------------------------Capacity-------------- ---- Disposal_F�ield: Distance from nearest well-----------------Distance from foundation--/-,a-_-------- Distance to nearest lot line--S----..----- Number of lines--------/-------------------------Length of each line--.__3_ .-`____-------.Width of trench........ ---------------------- S.—/ --X.--�.-.---._-- Type of filter material�l'bC-1 -.-_._Depth of filter material--...1e_f ----Total length-----------�4--- --------------- Seepage Pit: Distance to nearest well.- --------------Distance from foundation---- ..�.---.Distance to nearest lot line��---- Vj [ Number of pits....--/-----..-.-_--Lining material-_--�s�sC-�ize: Diameter____3 --°._--Depth___.__Z- ----------------- aQ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material------.._._.--.-.-_.-------------.---. ❑ Size: Diameter--------------------- ----------------Depth----------------------------- ---- - - -------------Liquid Capacity----------------------------gals. m Privy: Distance from nearest weil-------------------------- -------- -- from nearest building---------------------------- - ❑ Distance to nearest lot line---------------------------------------------- -------- 1 �1 Remodeling and/or repairing (describe)----------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------ -----------------------------------------------------------------------------...---------------------------------------------------------•----------------------------------------------------------- ----------------------- ---- ---------------------- ----------------------------•----------------------------------------------- ------------------------------------------ - --- --- ------- ---------- hereby certify that I have pr pared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules d re ulations o he San Jo urn Local Health District. (Signed) -- . - ---- - -------- ------------ ---------------------- (Owner and/or Contractor) By:------------------------------------------------------------------------------------------------------------------------------------(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 APPLICATION ACCEPTED BY----------------- ' ---------------------------------------- DATE---------- ------------------------------ REVI EWED BY------------------------------------------ -- -------------------- ----------------------------------------------------------- DATE------ ---------------- - --------------------------------- ----------------------------- BUILDING PERMIT ISSUED-------------------------------------------------------------------------------------------------- DATE--------- -------------------------------------------------- Alterations --------------------------------------------. .Alterations and/or recommendations----------- --------------------------------- ------- -------------------------------------------------------------------------•------------------------------- -------------------------------•--------------------------•----------•--------------- --------- --------------------------------------------- ------------------------------------------------------------------------------ ------------•------------------------ --------------------------------------- ------------------------------ ---------------- --------------------------------------------------------------------------------•-------------- FINAL INSPECTION �--...-�------------------------------ Date. ---------.--------- -------------- --------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1661 E.Hoxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca, California Tracy,California F.P.CO.