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FOR OFFICE USE: -------------------=-------=---------- ----------------- __________ APPLICATION FOR SANITATION PERMIT Permit No. ; ice - (Complete in Duplicate) ,�, Date+lssued ---------------------------- -- ------------- ------ : This Permit Expires I Year From Date Issued C � Application is hereby made to the San Joaquin Local Health District for b permit to construct and install the work h .erein described. le This application is made in compliance with County Ordinance No. `< V40 , JOB ADDRESS AN 'LOCATION.. ----.-----�`" i� , - -- ••---------------------- ---4_�..f___.___ �� Owner's Name_ ------ ------ --- ---------------- Phone------------------- -----------' Address I__TA:___ '. ------- ------------- �� f `4 Contractor's Name ----•--•--------------•------_------------------------------------------------------ •---------- Phone---------_--------------•--------•- I Installation will serve: Residence +Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -1----- Number of bedrooms !�!---- Number of baths I____ Lot size --------- --------- --------------------- , Water Supply: Public;system L] Community system E] Private W -Depth to Water Table 07 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam W Clay W Adobe❑ Hardpan,W Previous Application Made: (If yes,'date------ -------------} 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.) _ � r Septi ar Distance from nearest well_________________Distance from foundation-------------------Material--------------_- '____.____-_.----------------- r No. of compartments-------------------------Size--------------------------------Liquid depth-------------- -----------Capacity----------------------- isposai Field: Distance from nearest well_ ----------Distance from foundation---A --------- Distance to nearest lot line_s____._______ I ' Number of lines-__t_L______.___ Length of each line--/ '' 9 �---------- --------------Width of trench- �'-�--:------------ - ---- '. „YType_of.filter material p _� -Depth of filter material_____ -----------Total length_._/-Tb-!_----_---- : f � c Seepage Pit: .Distance to nearest well_�B�'__-,/ ---_Distance from foundation______ _________.Distance to nearest lot line__..._-___.____.. P Dd Number of pits---- ----------------Lining "material._-____Size: Diameter__.s3.3 --------De th_ f p ---------------------- Cesspool: Distance from nearest well_________________Distance-from foundation--------------------Lining material__.___--._.________.________--_--- ❑ Size: Diameter--------------------- -------- -- --De Depth ----------------------------------- ,� Y -- =-----Liquid Capacity----------------- ----------gals. rjr Privy: Distance from nearest well_____3-__,-.-_ .� ------------------------------Distance from nearest building------------------------------------- ❑ Distance to nearest lot line---- Remodeling and/or repairing (describe): ------- ------------------ ---------- ----------------------------------:------------------- \ F-------------•------------------------------------------------------------ -------------------------- -------------------------------------------------- -------------------------------------------------------------------------------- t :- -°--------------------------------------------------------------------------------------------------------------------------------------------------- ----=- I hereby certify that l have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)g ) - -- ----- --- ___________________(Owner and/or Contractor) '1 . $.Y�-----------_: -------------------------------=--------------------------------=--------------------------------------(Title}:::-_.-----------------'-------- *Ja - - - - - -. �.-- ia+ (Piot plan,.showing size of lot, location of system in relation to.wells bbuildings, etc',can be pplaced ann reverse side). . FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED $Y_---- ------------------------------------- DATE___4_'_'_11-/-� - - REVIEWEDBY ----------==------------------------------- ----------------------- -------------------- DATE BUILDING PERMIT ISSUED-------------_---__I_____:_ ------=- = DATE --------- Alterations and/or recommendations:-�-------------- -- -----------------------------------------------------•---------- .. i ------ ---------•------------------- ------------------- I I , -------------------•----------------------------------•--------- ----- ---- --------------- ----------------------------------------•----------------------------------------------------------------------- --------------------------------------------------------------------- ---------------------•------------ - ------------------------- -- ------------------------------- ------ - - ------------------------------------------------------------- -------------------- --•----------- --------- FINAL INSPECTION BY:.�,.: � � T ----------- Date--__ _------------ �-- - - ----- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California FS 9 REVISED 9-S9 3M 3-'63 F.F,CO.