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FwOR FFIC� SEy7WZ APPLICATION 3 FOR SANITATION PERMIT Permit No. - ---------------------------- in Du licate y �' (Complete P I _ / Y ----------- ---------------- -------- ----------- a a installDat work herein descrbe �`�.:�-�s�':s• 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 he This application is made in compliance with County Ordin rice No. 549, JOB ADDRESS ANDLOgATION____ Owner's Name 1—`./I ------------------------ -- - - Phone Address------------------------------ -- - ------------------- ------------ ------------------------ Contractor's Name---------------- _ � __. ._- Phone..............•--------.- •----. ... � - Installation will serve: Residence 2a—Apartme t House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: .7-- Number of bedroomsy____ Number of baths .Z-- Lot size ____ Q-__._ '6_____________________________________ Water Supply: Public system [n�Community system ❑ Private ❑ Depth to Water Tablet ZR ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Ej—Hardpan ❑ Previous Application Made: (if yes,date--------------------) No New Construction: Yes Er"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 Tat n Distance from nearest well----------- Distance from foundation--------------------Material-------.____________________________-.______----. No. of compartments-------------------=-----Size--------------------------------Liquid depth--------------------------Capacity---------------- Disp al Fie �j Distance from nearest well_________________Distance from foundation------------..._-Distance to nearest lot line--------.------- . I � � ✓ Number of lines-----------------------------------Length of each line------------------------------Width of french---------------------------------- Type of filter material-------------------------Depth of filter material___________-__/-------Total length------------------------------- Seepage Pit: Distance to nearest wel�________Distance fo ndationj .-----------Distance to nearest lot line__ ^_..-.. Number of pits------I-------------Lining material--- -----Size: Diameter_..-. r3-------------Depth-----------Z�C__________. Cesspool: Distance from nearest well_________________Distance from foundation-------------------.Lining material--------------------------------- ❑ Size: Diameter--------------------------------------Depth----------------•-------- -----------------------Liquid Capacity------------------------....gals, Privy: Distance from nearest well_______________________---------------------------Distance from nearest building.____..._____-_____--__---______..___.._. ❑ Distance to nearest lot line-----------------------------------------------------------------------------------•-------------------------------------------------------- Remodelingand/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 rule an regulations of the San Joaquin Local Health District. ------- ---- ---- ---------------------------- ------------------------------------------------------ ---._.Owner and/or Contractor {Signed)--------•--••-----� --------- - ( � Br• ----------- (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---- -->--tea ° Y� -------------- DATE----- /------------- , REVIEWED BY-------------------------------- --------------------------------- ------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------- ----------•--------------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:____ _..--------_.---------- ---------------------*•------------------------------------; -----•---..--•-------------------------------------------------------•---------------------------------------------------------------------------...--•------------------•---------------------------------------------------- ----------------------•-------------------- ----- -------------------------------------------------------------•--------------------------------------_...•---------------------------------------------------------- F _________________ _ -----------_--------------_---------------------------------- _�__________n_____________________________-________________________________________________________________________________________________ FINAL INSPECTION B 1_S:-- Date---------- -------------------------••- ry JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California £8.9 REVISED 9.99 F.P.00.2M 6-60