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FOR OFFICE.USE: _ ----------- APPLI ATION FOR SANITATION PERMIT Permit No. .........-�,� . ----------------------------------------------- (Complete in Duplicate) Z-- --- -------------------------------------------- I This Permit Expires 1 Year From Date Issued 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. J �` `,�„ll, M 0 � '? - JOB ADDRESS A D LOCATION.._._ XJ._ - �� ,x' � ~,-' �,,,-„ „,, cw.. ,,, •,_,,, L Owner's Namef _1Q.1fi 4 Phone1rQ_..' 7_?,�it� Address------------J3,2......_N....�.. . Contractor's Name.- --- �� J�-T 1 J F �� ....................................... Phone...6jg'�`. Installation will serve: Residence gb—;O�p'artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/... Number of bedrooms. Number of baths _1... Lot size -��.�r..�...._l Q©..........._ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No K New Construction: Yes Jam►. 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 n l� / p Barest well from foundation----- ... No, of compartments.--Z.____.•_____-.-_Size.�a___��_ .___Liquid depth_..c5._S_.-__-______Capacity.tQOl?. � Disposal Field: Distance from nearest well___.__- Distance rom foundation....,/.O.* Distance to nearest lot line.......... Number of lines-..--_/--- .__ ___ _._Length of each line..... _F�_.*......Width of trench..... Type of filter material._._._ .�_ _.__.Depth of filter material....//J-P"%------Total length......10.0.''___________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation....................Distance to nearest lot line............ ❑ Number of pits______________________Lining material-••_______.____-_______Size: Diameter-----------------------Depth.............._.................. 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, e I , and rules and egulations of the San Joaquin Local Health District. (Signed) —T ... -------------------------------------------------- -Contractor) By:--------•••---••------------•......................•--••----••-----------•--•- t ----------(Title)-••--------•-----•--•-•----••-•------•----------- ---- --------- (Plot plan, showing size of lot, location of system in relation ells, buildings tc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY..... ... ......^------__---------------------------------------------------------- DATE. -...3 G �- ----------------------------- REVIEWEDBY....................-...........•-•-----•------------------------ ----------------------------------------------------------- DATE........................................................ BUILDINGPERMIT ISSUED..............................................................–...................................... DATE............................................................. Alterationsand/or recommendations:.......................................................................................................................................................... ...------•-----•--••----...----•••-•.............•-•••......-•---------•-----------•-•---...--•------------------ ------•--•-•-••----•••-•-••---•---•-•------------•----------•-••-----••--------•------_....._...._.......- --------------------------------------------------------------------------------------------------•---------•-----------------------------------------------------------•---•-------------------------•------•-----• ---••- ._....-•-----•--•--••-••.............•----•---•-----••---•-._...--------------------:..---------.....-••-------------------................................................................................................. !/ r: - FINAL INSPECTION BY:-----f - -------- `�� DatekSAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 Wort 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 0-59 RM 6-61 ATLAS