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FOR OFFIq USE: 6 r• .1 fff ----------- ls.3 -------------- -------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...y........ .._.. .. ----- - ------------ ----•----- (Complete in Duplicate) 33/ * This Permit Expires t 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 N P S49. -r.—_(/ JOB ADDRESS AND LOCATIO .._�..��--�fg{��___-�---�- , -------, . X� Owner's Name .:_.. ----------- Phone.................................... Address-_-._ ... . ------ --•----------- i Contractor's Name------------ ---- ---- •--�--- --- -----------------•-•-------------.-...--------•-------------------......------------ Phone---•------•------------------------ � Installation will serve: Residence Apartment House Commercial ❑ 1 P ❑ ❑ Trailer Court ❑ Motel ❑ Other / Number of living units: ._ Number of bedrooms -- --- Number of baths of . Lot size _ . .. ._------------------------• -. Wafer Supply: Public system [j9- 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 ❑ h\� Previous Application Made: [If yes,date--------------------) No [!r New Construction: Yes ❑ No g?- FHA/VA: Yes ❑ No 99-- TYPE 9 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SepticJank:. Distance from nearest well_---------------Distance from foundation-------------------.Material____-.....--------------.......__.....___........ tRI 511wf No. of compartments--------------------------Size-------------------------------Liquid depth.. . ... . -Ca eci --------------- ....... Disposal Field: Distance from nearest well-----------------Distance from foundation...........---------Distance to nearest lot line.................. 49 0 -` -% Number of lines------------------------------------Length of each line------------------------------Width of trench------....----------------------- Type of filter material-------------------------Depth of filter material----------------------- length_---__--.___..__..--_- -••-•---•---------- Seepage Pit: Distance to nearest well------ f om foundation...IP---------Dista"e to nearest lot line---4-7..._--. Number of pits...--1-------------Lining material_ ;1 --.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----------- -------------- Remodelingd repairing (describe):and/or re P 9 { ) L !' ------------------------------•-------•-----•---•--------•---••--- - --------------• ----•----•-•-•-.._.....--------.......---------------------------------------- ---••--------------------•------------------------------•---------------------------------•---------------------------------------------------•--••----•------•---•---------------•---.---------------•------------- - 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 +h, a Sen Joaquin Local Health District. (Signed)------------------------------`.6 'H' . ........ -------------- - --------------- _( or Contractor) - "BY= (T ---------------•- --- --- ---- Rle.... ....... ------------------ (Plot plan, showing size of lot, location of system in relation f ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------- , ---- ----------------------------•----------- DATE---- �-------------- REVIEWEDBY------------------------------------ ----------------------------------------------------------------------------------------- DAT •-- BUILDING1SSUED------------------------------------------------------------------------------------------------------ DATE. Alteration and/or recommendations--------------- --------------------------------------•-._....-------------------------------------•----...._-..-----... f --•------------------- ��`� --------------------------------•----------+._..------------------------------------------------•---�� FINAL INSPECTION BY:.-- ...-. ,� -------_ Date--------------- -.�'-.G 3 .------------------------------------ i SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Srreet 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B•59 214 3-E1 ATLAS