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FOR OFFICE USE: d- APPLICATION FOR SANITATION PERMIT Permit No. ....... � �.-_--. -------------------------------------------------------- (Complete in Duplicate) Date Issued - -- -------------------------- -- ,., __._._____._._ This Permit Expires ces„1 Year from Date Issuede_,__ 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. S49. JOB ADDRESS AND CATI N i ---- --�-�------ �- • d Owner's Na -- - -i-•--- - --- -----•• - ---•----------------------------- - ------------ ------------- Phone----••------------------------------ Address..--- --•F•-a•••- �. - --f------•--------------- ---....------------- ------ - - --- ---- --- ----- - Contractor's Name........... ---- •--- - ----------------- --t -------------------- Phone----------------------------------- Installation will serve:. Residence . Apartment House ❑ Commercial ❑ Trailer Court-[] Motel ❑ Other ❑ Number of living units: __-- Number of bedrooms --umber baths __I___ Lot size---�4- --Zdf - -------------- Water Supply: Public system ❑ Community system ElPrivate Depfh 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 ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: t (No septic tank or cesspool permitted if public sewer is available within .200 feet.) ' o Septic ank: Distance from nearest well----_�d---__Distance from foundation---_1. _.____._ Material..---- !/ dam.. .................. No..of compartments _Size. __Q p .�----------- �-,/r-/----��---Liquid depth--------lj�---------------Capacity---9-��- A I Dispos /Field: Distance from nearest well--_ L?-.�-Distance from foundation-----/_ _�__Dis#ante to nearest lot line__'__..___._ 71 Number of lines_____ �_._____ _._ Length of each line---`„ -- ---- __.Width of trench-----.vZ--------- ____________ Type of filter material- ____--Depth of filter material__:__- -_-._-__Total length----- __Q_0-------------------------- „.- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line---------------- El 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 lotline--------------------------------------------- ------------------------ ------------ --------------------------------------------------------- I Remodeling and/or repairing (describe)---- ---- ------ ----------------`----------------------------------------••-•-----------------I--------- --------- --------------------- s.rs..----•------•------------------- -- --------------------------------------- ----------------------------------------------------------------------------------------------------------- --------------------------------------- - ------ -------------------------------------- ------- -------------- I hereby certify thaf_L have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws an ules and regulations of the San Joaquin Local Health district. 'r (Signed)---- --- _ er and/or Contractor -- - - ----------- BY:.-•-- -- z------ ---- ---------- ------- (Title)-------------- :.._.. (Plot plan, showing size of lot, location of system in relation to we , buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ --------------------------------------------------------DATE----_ _=�Z_'_ _..___-__.--._-..-.__--__ -------- REVIEWEDBY----------------------------- -------------------------------- --------------------- ------------------------------------ DATE------------ ----------------------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------- --------------—----------------•-------------------- DATE------------------------------------------------------------ Alterations and/or recommendations-------- ---------- --------- - -•- -- --------- ----------------------•--•- -- ------------------------------------=--------•- ---------•----•---------- - --------------------------------------------------•------•--•-------------------.------------_----------- ............ ............. ------------------------------- ------------_____----------------_-------------------------------------___________________---------_--------------------------------------------------------------------___ -------------------------------------- ------------------------------------------------------------------------------------------------------------------------•-•-...____-...-.-----...-------_---._---_------.--------.__-.____-._._--'-----------_-_--_.__-------- FINAL- INSPECTION ------------------ _ Qate,- =ff .~ .:f:-. ti------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California M E5 9 REVISE❑ 8-59 3M 3-'63 F.P.00. -