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FOR QFFICE USE: ---------------- -------------- -------------- --- APPLICATION FOR SANITATION PERMIT Permit No. ----------- ---- -------------------------------- (Complete in Duplicate) ------------------------------------_------------------- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Healih District for a permit to-construct and install the work herein described. This application is made in compliance with Cou ty Ordinance No. 549. I JOB ADDRESS AND LOC T F ---------------------------------- � - P -------------- er's Name... ------=---•- ------ ---- ------------------------------= -------------- --------------------- - --------- ---- ----- - ---------- - ------------ ---------- ---- --- - Phone Own AContractor's Name--------- -- - - --- - ----- - • - Phone----. .--------•-------....------- ddress----- Installation will serve: Residence ❑ Apartment House ❑ Commercial railer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms _ _ Number of baths Z__ Lot sizey /`! --- ---------------------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe [Hardpan ❑ Previous Application Made: (If yes,date--------------------f No 9?"�New Construction: Yes ??'—No FHA/VA: Yes ❑ No B-- TYPE OF INSTALLATION AND SPECIFICATIONS: i .(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic.T ak: Distance from nearest well----------------- from foundation--------------------Material-_-._-__._--.---_-.-._.._-._-___.-----------_. C' No. of compartments-------------------- -- Size---------------------------------Liquid depth--------------------- ---Capacity-------------------- Disposal ----------------fDisposal Field: Distance from nearest well__J< D_..._Distance from foundation-.-_- -------.Distance to nearest lot line.IN-------. ,,■■,, Number of lines---.----�--- �_---- - -.-. _Length of each line-- - -- -__ -.-Width of trench__.2�_._-`------------------- Type of filter material_/ -Depth of filter material-- .____-_ s Seepage Pit: Distance to nearest well___/.ffo'P___-__Distance fro fo ndation___ --------- D'stan� to nearest lot i�e_Z_.. -_.__. --- Number of pits.-..-/----- ---_Lining material__ _--Size: Diameter.-. e� ...___-__Depth,1 _ -.- i Cesspool: Dlsfance from nearest well-----------------Distance from foundation--------------------Lining material-...---------------------------------- rn t El ' Size: Diameter------------------ ------- ----------Depth------ -------------------------- -- - --------- Liquid Capacity gals. .r Privy: Distance from nearest well-------------------------------------------- --Distance from nearest building ---------------------------------------- ❑ Distance to nearest lot line--- -- ------------------- --------------------------- ----- ----------------------------------------------------- Remodeling and/or repairing {clescribe)--------------- -------0101.,_-- -�----- _� ------- - --- ------ ---------- --- ---------- ---------- ---- --------- ----- ----------------------- ------------------------------------------------------------------------------ -------- --------------------------------------------------------------------------------------------------------------------------------- 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, and rules 'a regulations of the San Joaquin Local Health District. (SigneOle d) ---------------(0�v Contractor) ----------------AA f By=----•----------_---- ------------ `------- -- - fto - e-----------{Title) ---------;- -- - ------------ (Plot plan, showing size of lot, location of system i r tionwells, buildings, etc., ,can be placed on reverse side). r FOR DEPARTMENT USE ONLY _._ �... --- �--------------- APPLICATION ACCEPTED BY.___. DATE � � 1'j REVIEWED BY-------------------------------------------------------- -------------------------------- --------- ---------- - ------------ -------- ------------------------------------- DATE------..------------------------------------------------.--- IBUILDING PERMIT ISSUED------------------------------------------- --------------------------%-----------------------•----- DATE----------------------------------------------------------=- Alterations and/or recommendations:------------ --�---( - &--�_------ � "`' l '------------ - ------'--------------------- .---...... : C --------------------------------------__•-----------------------------------------.------------ ---------------------------------------------------------------------- ------ -- ------ -------------------- -------------------------------- -------------------- ------------------------------- ---- ------------------ ------ - -------------------------------------------------- ------------------------------------------ --------------------------------------------------- ----- ----------------------------------------- -------- -------------------------------- ---------------------------------------------------- -•------------------------------------------------------------------------ F1NAL INSPECTION 6Y: /`' ''t ------ Date .... -G----- ------------------ ------------- 4 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.