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FOR OFFICE USE: -------------------------------------------------------- - APPLICATION FOR SANITATION PERMIT Permit No. --------------- ----------------- om -------------- (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 described. This application is made in compliance with County Ordina ce No. 549. 4,10 ,j' ,o n , JOB ADDRESS AND LOCATION .��X-- +-' .... �� `" hm.7, -" re Owner's.Name- ------------------------------ ----------------- ---------------------------•---------------- Phone------------------------------------ Address---------- ----f�---- -- -•----- -----------------------------------•--•--------------..................... Contractor's Name.............. ------- . -•-•-• ----------• Phone............................ Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court'❑ Motel ❑ Other ❑ Number of living units: __/.___ Number of bedrooms .__?-�_N umber of baths ..-/--- Lot size ------___________________________ "-•-_.--_-________ Water Supply: Public system ❑ Community system ❑ Private gr"'Depth to Water Table ___ :.. ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Ek Clay ❑ Adobe❑ Hardpan 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.) Septic Tank: Distance from nearest well-----------------Distance from foundation------------------..Material--------------------------__........._...__-____. ❑ No. of compartments--------------------------Size..........--------.......------.Liquid depth....----------------------Capacity........----------•---. Disposal Field: Distance from nearest well------ ---------_Distance from foundation....................Distance to nearest lot line----------------- F-1 Number of lines.:.-----_------------------------Length of_each line__--.--------......---------Width of trench.............-.------------_-- ---- Type of filter material-----------_-------_____Depth of filter material____.-__-._..__-_-____Total length---------.___..-_:__-----.-_-----___--_-__ i------ See Pit: Distance to nearest well----- from foundation....-lo........Distance to nearest lot line....s._____--_ Number of pits__."__�_____-._____Lining rnaterial__._-5'12'--------size: Diameter.__... 3_ '.____Depth----S_s.................... Cesspool: Distance from nearest well... ...'Distance from foundation -__.__........Lining material___ .------__-,__...... .......... ❑ Size: Diameter----------------------------------- Depot==_: ----------- --- -----------Liquid Capacity.-.-.---------- -----gals. Privy: Distance from nearest well-.,- _"-_--.-_. ____ __________"_.___Distance from nearest building___"__-_---------_.........___._--____.. ❑ Distance to nearest lot line------1 -•----- -------------- -------------------------------------------------------------- --- -------------- Remodeling and/or repairing (describe):_ ______ ---- ---- ----- - ---•--------•-------------- ------•----------- ---------------•-- ............---------------------•-"--------------- ----------------------....... ---------•--------•--------- -----------------------------------------------••------------------- -------------....................................-"---------•-•-----------•--•------------------ N --------------•-------------- ----------------------------------------............------------------------------........ ---------------------•----------.................-------------------------------- 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)--------------- ------ ------- ---- -------------------------- Owwfyand/or Contractor) BY: � - ----- -------- ----- (Title).. - - (Plot plan, showing size of lot, location of system in r ation to wells, buildings, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ ------------------------ /Ct .o ----------------- ---.- : ----------------•----------_ DATE------A. -------- - � . REVIEWEDBY----------------------- ----------------------------------------------------- --------- -_---------- DATE..---------------------•---------------................ BUILDINGPERMIT ISSUED..........................--------------------------------....-.....-.........•........--- -•-•-• DATE--------------------------------------------- --------------- Alterationsand/or recommendations:------------------------------"--------------.......................----------.....................................................-.........--........------- - ------------------------------------------ ------------------------------------------------------------------------------........------------------------------------------------- ------•--------------- ----------------------- ----------------•---------- -----------------------...----------------------------....-----------.............------------------------------------------------------------- FINAL INSPECTION BY:/4 ' ______ __------- Date-,..---)--.----- -/ 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.CC.