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FOROFFICE USE: -------------------- ------ ._-.--_�------------------- -----------------------_- APPLICATION FOR SANITATION PERMIT Permit No. _..�.. :��..__.:: -------------------------------------------- ------------ (Complete in Duplicate) Date Issued -- ----------------------------------------------------- --- This Permit Ex ices 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 LOCATION---— ------- ,r-+ter..---------- Owner's Name `-�. Phone-.�i��...4�- -7--•---- -�-+ `� Address �! _ ;>----------- ----------------------------------•--------------•------------•-•---•----•-•--------- ---------------------------...------------------- Contractor's Name... . ---••---• Phone----------------------------------- Installation will serve: Residence Apartment House p Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-4-- Number of bedrooms .eP—_ Number of baths ---L Lot size ------j- r�-- - ..Sp---------------------- Water Supply: Public system X Community system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeZ Hardpan ❑ Previous Application Made: IIf yes,date--------------------1 No $ New Construction: Yes [Z 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 nearest well-----------------Distance from foundation-------------------Material------------------------------------------------- No. of compartments------- ------------------Size-----------------------••-------Liquid depth---------------- ---------Capacity--•-----•-------------- Disposal f=ield: Distance from nearest wellrM.-,?,-e---Distance from foundation-----_-/0 .....Distance to nearest lot line-__,5*........ Number of lines-------------/-------------------Length of each line_.__.---_JA-- --------Width of trench-------- -_-------_.----_-----_ r Type of filter materiaL4-c --.Depth of filter material------/-y----------Total length---------- ------ ------------ \W Seepage♦ � Distance to nearest wall--:rr Dista rice from foundation---___-/!a-_t_.Distance to nearest lot line------- Number atlFr ---------------Lining materialll� c_ ize: Diameter-------�_-_----_--Depth------fes_ 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 ;ine--------------------------------------------- --•--------------------- Remodeling and/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, State I and rules and regulations of the San Joaquin Local Health District. (Signe.` [/� ----------------------------------------------------------------------------(owner, and/or Contractor) -------------------------- B ----(Title) ---------- --- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). �l FOR DEPART ENT USE ONLY APPLICATION ACCEPTED BY--- ��` �--------------------------- DATE- -------- ATE - -_----- ---- REVIEWED BY. ---------•--------------- ------------------------------------------- DATE.--. ' BUILDING PERMIT 155UED -------------------------------------------------------------------------------------. DATE. Alterations and/or recommend ions:---- 0 ----- ----------------- -----•----•--------------------------------------•-----••-------••-------------•-----------•-------------•---•- ----------------------------------------------------•------.-----•--------------------------------- ------------------------------------------------•-------------•----------------•---•--------------------•-•-------------- -----------------------------------------------------•---------------------- --------------- -----------------..-------••---•-------•-----------•-----------.---.--------------------------- -------------------•--- ------------------------ ---•-----------------------•----------------- --------------------------------------------------•---------•--•-------------------------------------------- -------------------------------- FINAL INSPECTIONBY---- - Date 1 ..- b SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES-9 REVISED 9,59 F.P.120.2M 6-60