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��R FFICE USE: ------- ------ APPLICATION FOR SANITATION PERMIT Permit No. ....�./.._ ----------------------------------------- ------- --- -- (Complete in Duplicate) ` ------ µ . This Permit Ex ires 1 Year From Date Issued Date issued .-_ �_ __rp Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. I This application is made in compliance with County Ordinance No. 549, �_JOB ADDRESS AND L ION_ "'""�YY ------------- Owner's Name. ------- ------------- --- -------------•= ------ Phone------------------------------------ Address-.----- ------------------------- --------Address-------° --------- --- .'I � -,l - - I ,Q --- --------------------------------------------------------------------------------------------------- f Contractor's Name ' ! ---.- Phone----------------------•-- -- ' Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ----/---- Number of bedrooms. --- Number of baths x Lot size Water Supply:pp y: Publicsystem ❑ Community system ❑ Private R`OOFepth to Water Table 4�>s"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 g?"'Do ❑ FHA/VA: Yes No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 5- (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearestwel-_!e--____-Distance from foounclation_A ---_.....Material u?" No. of compartments-.- _----------- --Sized _'%h0V r0___Liquid depth__-.-� �._._ ----Capacity_lZeQ------ Disposal Field: Distance from nearest well__;;;11�___._.Di' - Distance from foundation___�� ___._..Distance to nearest lot line_.-_______ . =�- ®r- Number of lines-'-.------e2._ __ Len th of each line____ -J•------- ----- 9 _4A�- -------- .Width of trench---a ---- j ------------------•-i , 7. Type of filfer material__ !._.Depth of filter material-- length length----Xs_V---------- 01 � � Seepage Pit: Distance to nearest well----�,��-------Distance frofn foundation___,��__.Distance to nearest lot fi�___ ___________ Number of pits__I__c� ---- material-_- C. ..�..Size: Diameter__s?9-_-----_Depth_07e'�_zpze� Cesspool: Distance from nearest well___-------------Distance from foundation-----:---------------Lining material-------------------.-------._-___.___. ❑ Size: Diameter.- I------------------------------- Depth---------------------------------------- --- __Liquid Capacity--=--------------- --------gals. Privy: Distance from nearest Well--------------------------------------__---------Distance from nearest building------_--------------------- ❑ Distance to nearest lot line------------- ---------------- ._ Remodeling and/or repairing (describe):--------------- •------------------------- 1 E -------------------------------------------------------------------------- - ----------------------------------------------------------- -------------------------------------------------------------=--------------------- =---- 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]---------------- -------- = Contractor) By:----------------------------"------------ --=---------------------------- - - , - - ----------= (Title)_ (Piot plan, showing size of lot, location of system in re! n fo=wells, buildings, eft., can be placed'on reverse side)., FO DEPARTMENT USE ONLY -` <% APPLICATION ACCEPTED BY--------------- ------------------------- -- '. - ------------- --------- ------- DATE---- - -- ---•�.�' ------- ------- --- BY --- -- --- ------------------------------ ---- --------- DATE------ -- ---- ------------------ BUILDING PERMIT ISSUED-------------- _DATE' -` --------------------Alterations and/or recommendations .-__-- -- _ 41� --------------------- ------ --- --------------------- . a- ; J., -=-------- - - � . - , { - _ - -------------------- ----------------------------------------- FINAL INSPECTION BY:...._ `.. Date__..... ------------ ------ = SAN JOAQUIN LOCAL.HEALTH DISTRICT a 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore-Street 205 West 9th Street a Stockton,California I Lodi, California Manteca,California Tracy,California i F.F-.co. r