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FOR OFF[ E SE; j '' -._. ----------------- ------- -------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .... ---------- �j. --__-----__. (Complete in Duplicate) Date Issued -------------- ..-��--�-- I_ . .- __.::_ 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 Ordinance No. 549. . f! -------------------------•--------- JOB ADDRESS AND LOCATION.....--- ll- ------ ^-Q Owners-Name----- - ----•- •---- --- •--------- Phone----•--•--------------------_---- ------ ------•---- t Address-------------------• --- ----------------------------------------------------------•------•------•---------- � 3 Contractor's Nam - -------- _--�•----•-----------•-------------- -•------- Installation will serve: Residence R"Apartment House ❑ Commercial ❑ Trailer Court ❑ `Mote! ❑ Other ❑ Number of living units: _ :__ Number of bedrooms .I-_ Number of baths ----1_ Lot size T ft. Waters Supply: Public system �` Community system E] Private ❑ Depth to Water Table - Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0' Hardpan ❑ Previous Application Made: (lf yes date____________________} No [��New Construction: Yes [B—No [:1FHA/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_____-_-_____-.-------•- ---------------•-----•------ Noof compartments--------------------------Size--------------------------------Liquid depth------------------------------Ce acitY--•-----•--•----- Disposal - � Field: Distance from nearest well-----------------Distance from foundation____________________Distance to nearest lot line__-.._.___.._._.. � '4V Number of lines------- __:---------------- ------Length of each line-------•--------•------•------Width of trench----------------------------------- Type of filter material-------------------------- Depth of filter material------- length___=_..._____...-------------------------- Seepage Pit: Distance to nearest-well_�'W.-----Distance.from foundation___-a'7____ _ _________Distance to nearest lot line_ ±_.y------- Number of pits_______ ____________Lining material_�..�_�--.__.Size: Diameter____ Depth---------- ,S""- -------- ( Cesspool: Distance from nearest well-----------------Distance from foundation------------------ _Lining material------------------------------------ Size: Diameter--------------------------------------Depth-----------------------•------------------------•---Liquid Capacity-.---------------------------gals. Privy- Distance from nearest well------------------------------------------------- from nearest building________._______-_-------:------------------ ❑ Distance to nearest lot line------------------------------ -------------------------------------------------------------------------------- Remodeling and/or repairing (describe)----------------------------------------- ---------------•--•-•-----------------------------•---------------•---- t 2 ------ -- ----- . __. -------- --•- - - - -----------------•--•-------...--- ----------------------------- •----- ---••---------•--- € s. ------------------------------------ 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] - --._...-Title ------------------------------------------- ----- ------ i By:- - -- _ (Title) (Plot plan, showing size offt, location of system in relation to wells, buildings, etc., can be placed on reverse side). 1 - I FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY----- C---.----_ ---------- DATE-----s=-1-- - --------------------------------- REVIEWEDBY------------------------------ ------------------------------------------------------------------------- ------------------- DATE-------------- -----------------•-----------•-------- BUILDINGPERMIT ISSUED--------------------------------------•-------------------------------------- - --------------.-. DATE------------------------------------------------------------- I Alterations and/or recommend ations:--- ._-'-�---(e--1----------Is{---- � _ �q�sl __- --- `-----0,_�4 F -'--------t---•---------------•------ --------------------- r FIiVALTINSPECTION`BY: G__ . F -- Date. z' �.. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Led[,California Manteca,California Tracy,California E6.9 flCViGCD 0.69 F.PX0.2W 6.60 r