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7 FO OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ... . ---------------------------------- ------ (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 Ordinance No. 549. JOB ADDRESS AND LOC ION- --------------------------------------------------------------------------- ------------------ Owner's Name------- ------------------------------------ Phone.................................... Address-------------- ---- t , Contractor's Name--------- -----------------------------------------------------------------------------------------------------------•---------------------- Phone----------------------------------- Installation will serve: Residence E4,`Apartment House ] Commercial ❑ Trailer Court. ❑`LMotel ❑ Other ❑ Number of living units: _l__ Number of bedrooms __A Number of baths _f._ Lot size � Water Supply: Public system 9?-**C*'ommunity system ❑ Private ❑ Depth to Water Table 67a ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe gg—o lardpan ❑ Previous Application Made: (If yes,date-----.--------------) No ®'' New Construction: Yes P4- No ❑ FHA/VA: Yes 54/'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 room foundation---/ -------Mated...4 -4e! .s ' --------- ' No. of compartments-----A--------------Si . - X_-�A_'.Liquid depth_A/' -__-�...._._._._Capacity..019VMP----__ Disposal Field: Distance from nearest well__y"""-_._Distance from foundation___1 .--_Distance to nearest lot Number of lines-------- Length of each line_-_- _ � ®� ,r 9 Width of trench ( Type of filter material_/J oDepth of filter material_. !F___--Total length_..._ o Seepage Pit: Distance to nearest well--------- ---------Distance from foundation----.ttl__.___.Distanc�g to nearestlotline_. �._�____i__ Number Number of pits_..__-----____---Lining material__��' _-Size: Diameter.--_ -_-..__DepthOZc!-1n/4x_c_ Cesspool: Distance from nearest well-----------------Distance from foundation.--------.----------Lining material__------___--_-_-_-------------- 1\ ❑ Size: Diameter- ------------ =-----------------Depth-.-------------------------------_----------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------.--------------------------------------Distance-from nearest building-----________________________________--- ❑ Distance to nearest lot line------------------- ---------------------------•---------•------•---•--•--------------------------------------------------------------- 41_ Remodeling and/or repairing (describe):.._._-_.--___ - ��/ / _� A� �: _________________________________________. --------------------------------------•------------------------------------•--------------------------------- -- ------ ----------------------- ---------------------------------------------------------------------------------------------------------------- ----------------------------•------------------ -------- ------ 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) �✓ — ---- ---------------------------------( /or Contractor) By-----------------_ ......------------------------------------------------------------ - - —- - -�-`---------(Title)-- "--------- -- - (Plot plan, showing size of lot, location of system in relatio wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY 14 ;41 APPLICATION ACCEPTED BY--------- ---------------------------------------------------------------------- DATE------- - -"�S --- --------------------------------- REVIEWEDBY------------------------------------------------------------------- ---------------------------------------------------------- DATE------------------------------------------------•----------- BUILDING PERMIT ISSUED-------------------------------- ---------------------------------------- `_. ------------------------- DATE--------------------- ot Alterations and/or recommendations: f 7 - `�'-�rf� -�x cz __... ------------------------ ----•----------------- -------------------------- ----•--------------------------------- ---------------------------------------- ----------------------------- ------- ---------------------------------- ------------------- FINAL INSPECTION BY:. -- - - 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.C O.