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FOR OFFICE USE: ;l r APPLICATION FOR SANITATION PERMIT Permit No. ...... ----------------- ------------- 5/7 f► ( -----------� _---_---_ (Complete in Duplicate) 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 describe This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND OCATI N------- --.-_? _...... �--------�r ►----------------------------•---------------- /j---------------- Owner's Name l�O -�Q...c L. ---------------•--------------------------------- Phone {�1rQ .9 Address-------------------------------------------- .......... ......................... Contractor's Name----------f1��l�.t'G_=-=to O�fl_ ---•-�-----•-'��'.`-=`. •- - ------- Phone---------------•-------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trciler Court ❑ Motel Other ❑ .. . Number of living units: .........Number of bedrooms .Z. Number of baths ---.._. Lot size .-g--e � �--- --+ Water Supply: Public system ❑ Community system ❑ Private g 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,date--------------------) No IV 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.)""� Se tic Tank: Distance from nearest well] 66Distan a from foun ation._ /./�N,C�.�_.Mater0l_---_-. p No. of compartments-------- Q'----------Sizeg--Xjl- � Liquid`depth------�------------- Capacity Disposal Field: Distance from nearest w I---61*14.Disfance from foundation..�i�.�Vjj,.-Distance to nearest lot line.-.. ./�'I/r! Number of lines__.......--�--- ---___-.- Length of each line---------.,r•.Q__- Width of trench..__.. .��--7---------- . Type of filter material..-�k _r_ Depth of filter material...__ -rr-.•---Total length___________ __Q-Q------- YP 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-----------------------....... r_1 Size: Diameter----------------- --------- ---- ---De th----------••--------•---------------- -----.Liquid Capacity. ------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building---.-----------.----------------.--------. ❑ Distance to nearest lot line----------------------------------------------- ------•-----------------------•---------•-------..--•-----•-------------•------••----•-------- Remodeling and/or repairing (describe) --------------------------------------------------------- --------------------------------------•-------••---•---- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- - ------------- --------------------------•---------------------------- ------------------------------------------------------------------------------------------------------------------------- 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 and regulations of he San Joaquin 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 ON Y APPLICATION ACCEPTED BY------------------------------------------ --------------- i , AC..... DATE ------ ----------------•------------------------------------ REVIEWED BY.---------------------------------------------- ----------- DATE----------------------------------------------------------- ------- BUILDINGPERMIT ISSUED---------------------------------------------------------------------------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations------------------------------ - •-----------------......•......................... --------------------------------------------- ------------------------------------------------------------------------- --------------------------- ----------- --------------------------------------- --------------------------- -------------------- ..................................................... FINAL INSPECTION BY:------ -----� --------------------------- Date----- -------------------------- -- - ---- - SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wast 9th Street Stockton,California Lodi,California Manteca,California Tracy,California E■-9 REVIOED 0.59 F.P.CD.2M 6.60