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FOR OFFICE USE: -- is--�� s',.-�------- --f APPLICATION FOR SANITATION PERMIT Permit No.-------------------- '� , ------------------ �---- (Complefe in Duplicate) r=----- --- This Permit Expires 1 Year From Date Issued Date Issued i 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. .r p r r JOB ADDRESSLOC TION Q - - - ------------------------------ F Owner's Name.___ ! ,y9 Contractor's ss = a Name-----•----------- --------------- ----------------------------------------------- Phone_ % Installation will serve: ;Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ .3 ' / -____ Number of bedrooms -_______ Number of baths __-____.,Lot size Wafter Supply: Public system Community system ❑ Private ❑ Depth to Water Table Sd ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe fZ Hardpan ❑ Previous Application Made: (If yes,date........._---------) No ❑ New Construction: Yes ❑ NoX FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ► (No septic tank or cesspool permitted if public sewer is available within 200 feet.) is Tank: Distance from nearest well________________Distance from foundafion--------------------Material -__-_-_______--______----.-______-___-______-- k No. of compartments------- ---- -------------Size----•-------------------------Liquid depth--------- ----------------Capacity----------------------- s sal Field: Distance from nearest well____-.`--_-__-____Distance from foundation____________ Number of lines______________ ________Distance to nearest lot line----------------- . ''` -- ------- -----------Length of each line------------------------------Width of trench ------------------- - ---------- Type of filter material_ _______ ___`_ Depth of filter material_-- -----__------------Total length--------.------------__-_____________-____ Seepage Pit: Distance to nearest a __ Distanc, m foundaticn_/CL_ Distance to nearest lot iineZa___-,--- L?� Number of pits.--___/------------Lining material_ _ 1JCIt-1_---Size: Diameter- ------_-___Depth_.....__ � --------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material__-_____________----__-_________--__ ❑ Size: Diameter----------------------------- --------Depth---------------y-------------- -----------------..-.Liquid Capacity- ----------- gals. Privy: Distance from nearest well------------------------------------------------- from nearest building----- --____--_____-_____ ❑ Distance to nearest lot fire - Remodeling and/or repairing (describe):--------- - ----------------------- --- - ---•----------•------------------------------- -------- -----------------------------------------------------------I------------------------------------------------------------------------------------------------------------------------- -- ------ 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 an regulations of the San Joaquin Local Health District. (Si ned ��i.�—� � - 9 } ------- ------ ---------------------- -- (Owner and/or Contract ---- ----- -- - -- -- --- --- --- ----------(OW d/o or) I By: -------------------------------------------- - ------ -- - -, (Title)- (Plot plan, showing size of lot, location of system in relation f ells, buildings, etc., can be laced on reverse side). FOR DEPARTMENT USE ONLY .- APPLICATION ACCEPTED BY-------- REVIEWEDBY------------------------------- ------------------- --------------------------- -------------------------------------------- DATE--------------------------- ----------------- - -- --- -------•--------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------------------------------- ------------- DATE-------------------------- Alterations and/or recommendafions:- C1/G' ----- - -- ---------------------------------- FINAL INSPECTION BY:----- r Date-------- `4� ' - - SAN JOAQUIN LOCAL HEALTH DISTRICT I 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F-p.CO.