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t-UK Urr-K-t: USI::; Y=G, -------------------- - - ---- ------------____--_.__-______---- __.-_______ APPLICATION FOR SANITATION PERMIT Permit No. . --------------- ----------------------- ---------------- (Complete in Duplicate) 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. JOB ADDRESS AN OCATIO ---- c ._ .' _.. •- "'�, -------------- -.--------- ---------------------------------- ----------•- Owner's Name---- �_.. --------- ----------- --------- ------ Phone--,,-------------------------------- Address-----14,r j-------- Contractor's Nam _ - --------------- Phone------------•------- -------------- - Installation will serve: Residence UD--?'�partmenf House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: 7 Number of bedrooms __4 Number of baths __/___ Lot size Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table /A'-_ ft. Character of soil to a depth of 3 feet: Sand Gravel ❑ Sand Loam (] Clay Loam ❑ Clay ElAdobe C] Hardpan E]Previous Application Made: (If yes,date.-..------- -----) No New Construction: Yes ❑ No ZK_FHA/VA: Yes ❑ No E-' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) p Se tic T Distance from nearest well_-t----.- Distance from foundation---eo�-------- _ ________________________ ______________________ No. of compartments___:' __________-_----Size___.3_ .;5' -_ ___.___Liquid depth_-__' ___'_-_-__-----.Capaci#y_.__ ---- ------ Disposal Field: Distance from nearest well.-470------Disfance from foundation__,&4_r----------Distance to nearest lot line_--'F ___�.--- Number of lines------I-----------------------_-Length of each line----------------------------- Width of trench--rg-Ir --`�------------------- U! Type of filter material_T4'G/(---------Depth of filter material __It_-� -----Total length------------------------------------------ �j Seepage Pit: Distance to nearest well-----_----------------Distance from foundation--------.-----------Distance to nearest ]of line_____-.______--_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth-----------.--------------------• Cesspool: Distance from nearest well-----------------Distance from foundation....................Lining material-------------------------------------- I_ ❑ Size: Diameter----------------- -------------------Depth------------------------------------------ --------Liquid Capacity- ------------------ -gals. Privy: Distance from nearest well------ ___________________-_ ---------Distance from nearest building ❑ Distance to nearest lot line------- ----------------------- `-------- -_--------------- Remodeling and/or repairing (describe):.-- -_ _ -- ------------------------ -----------------------------•----------------------------------•------ ---------------------------------------------------------------------------------------------------------•---------- I hereby certify fhao have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, StaVlaws, d r and regulat' a the Sa Joaquin Local Health District. (Signed)-- -------- ------------- ---- ---- --- F --------------------------------------------- - ------------------(Owner and/or Contractor) BY- ----------------------------------------------------------------------------------------------------(Title)------- ----------------------- --------------- -------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY DATE_3' REVIEWEDBY------------------------------- ------------ --------------------------------- ---------------------------------------------- DATE -- - ---------------- UILDING PERMIT ISSUED------------------------------------------------------ -------------------- ------------------------- DATE.------------------------- - -- --- ---------------- - Aterations and/or recommendations:------------_------------- -- ---------------------------- - ---- -------------------- ---------------------------------------------------------•----------------------------------------------------------- ---------- ----- ------------------------------------------------------------------------------------------------------------------------ --------------------- --------------------------------------- -------------- ------ ----------------------------------- --- ------- ----------------------I-----------i' --------------- k 3 - 6'�lO� FINAL INSPECTION BY:.--- ----------------- Date - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Mantecar California Tracy,California F.RCO. 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