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--- ------- -- -- yv // --- i -------- ------ APPLICATION FOR SANITATION PERMIT Permit No. (Complete in Duplicate) ............... ----- --- --- -�" This Permit Ex fires � Year From Date Issued 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 C n y Ord'nan No. 549. JOB ADDRESS AND LQCATION.�------ __- r: „ ,y.t t'� r -------- ..__r.r_._ Owner's Name--------- -------------------•---------- Address - . ------ Phone............... l ` / Contractor's Nama _..:J�c_�r € <:_--•- •- ••-•----------------- ------"- ------ Phone................................... Installation will serve: Residence P Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units. -1------Number of bedrooms _ '_._ Number of baths!_:' Lot size ____________ _ Water Supply: Public system ❑ Community system ❑ Private W Depth to Water Table 4'� ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam 4 Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,dote. -) No 14 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 fee+.) S-ptic Tank: Distance from nearest well_. ,6. - ___Dis#an from foundation_.._.LU_ No. of compartments.._. _.- . Liquid depth - ----- Capacity../,A, Com__. =- --- •Disposal Field: Distance from nearest well .=_`---_-_-Distance from foundation,-/_=_'_c.-__ "Distance to nearest lot line.-. -- Number of lines----__? Length of each line____15' -------------Width of trench-_;2--__j/..................... Type of filterDepth of filter material---------------- -------Total length__-:;,;, _-.--- 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 wel!____ _Distance from foundation---._.__.._.._-_..Lining material_....-.___-_-_____.-.____--____.-._ \ ❑ Size: Diameter------ ---- ---- -- - - - --------Depth.- ----------------------------- - -------- - --------- - ---- ---- --Li Liquid Capacity_ gals. q P ty_-------- ----------------- Privy: Distance from nearest well ______________ --- Distance from nearest building u ❑ 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 the San Joaquin Local Health District. (Signed) ?--------- -------- --- ---------- ---(Owner and/or Contractor) By:---------------------------------------------------- ---- - - (Title)__-------------- ----- --------------- -- (Plot plan, showing size of to+, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ---- DATE_.' ----- -REVIEWED BY---•-------- --------w- --------- ------------------- - ------ . ---- DATE_._.__.-.•------•------------- BUILDING PERMIT ISSUED------------------------- -- - -------...--------•••------- ---- ----------------------------------------------------------- . DATE__. Alterations and/or recommendations:__.- ---------- ----_------------------------ _--------------_..------------------ FINAL INSPECTION BY;t_.._- = bate -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 305 West 9th Street ES 9 REv,5Eo a-59 FM 5-51 ATLAS Stockton,California iodi,California Manteca,California Tracy,California r.•`a