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FOR OFFICE USE: ----------------------------------------- -.�a______. 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 Prdinance No. 549. JOB ADDRESS AND LOCATION___--�-- Owner's Name----- ...-.---... A -'='-'•------------------------------------------------------------------------- Phone------------------------------------ Address............ _-.__-------------------------•----Address------------ C=f'-ri`---- ----- i ---------------- ••--.-.••..--------------------------.._._---- ------- --Contractor's Name-------- - - --- ----•-------------------------------- Phone......... Installation will serve: Residence Ament House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -----1_ Number of bedrooms _-Z-Number of baths __1._- Lot size .7/1-x_/- __ _______________________________ Water Supply: Public system e—c-ommunity system ❑ Private ❑ Depth to Water Table -_e.0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe[5-Hardpan ❑ Previous Application Made: (If yes,date--------------------) No [!r'--New Construction: Yes ❑ No ® FHA/VA: Yes ❑ No 2�-' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) T Sep -c a : /Distance from nearest well--------------___Distance from foundation------------_-------Material------------------------------------------------- 6* J No. of compartments------------------- ----Size-------------------------------Liquid depth.------------------------Capacity•--------------------- Disposa Fi Id' Distance from nearest well_________________Distance from foundation___---__-.-----_--_.Distance to nearest lot line_-___.-___---_.__ Number of lines___________________________________Length of each line------------------------------Width of trench-----------------------..--.__--_--_ Type of filter material--------------_----------Depth of filter material---.-------------------Total length__--__-_--.___-___-____-_-__-_._--_---__-- CJI Seepage it: Distance to nearest well---__ ------------Distance m foundation-_3Q_..r___.__...D- tante to nearest lot line____------- •� Number of pits---._:?___.__.___Lining material._�� -----Size: Diameter----- 3_ -.-_._-Depth___.-_z ___--.-_.-._ N Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------.--_.--._----_-_-__--.-_ ❑ Size: Diameter----------------------------------..Depth-------------------------- -----------------------Liquid Capacity-------------------_ _ __ ___ _ _ _ _ ----------------------------------- _ --------gals. Privy: Distance from nearest well--------------------------------------------- from nearest building-___-_ ______ _____________________ P r_1 Distance to nearest lot line_______-__--____-____-_-._______________----------------------------------------------------------------------------- Remodeling and/or repairing (describe):----------------------------------------------------------------------------------------------- ---------------•-------•-----•----------•-- -•----------- -------------•--•-•-------------------------------------------------------------------------------------------------------------------------------------------- ------------- ----------------� ------------------------------------ ---------------------------------------------•--------------------------------------•----------------------•---------------------------------------------•--------------------------- �1 ----------------------------------------------------•--------------------------------------------------------------------------------------------------•-------------------------------------------------------------------- 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) -- - ---- -------------------------- -- --- ------------------ Contractor)- By:---------------- --------------------------------------------- -----------------------------------------------------------------(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-----------------'------- ---------------------------------------------------------------------- DATE-------a-� 3 {"',S REVIEWEDBY------------------------------------------------- ------- ------- --------------------------------------------------------- DATE--------------------------------------------------------•-- BUILDINGPERMIT ISSUED-------------------------------------------------------------•--------------------------------------• DATE_----------------------------------------------------------- Alterations and/or"commend tions:______ ____________ _ -------------------- - --- --------- --- -- ---------------------------------------------------------------------- - z --------- i � r _ 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.CO.