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-- - ----1 ----- - k- ------- --------- -- --------------- - - APPLICATION FOR SANITATION PERMIT Permit No./� 1-- I --------------------------I------- ---------------------- (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. j4/ JOB ADDRESS AND L CATION_ ____ ----------------------- Owner's Nam _ �_ ------------•----- ----------------------- ---- Phone---.-------- Address ----------------------- �__ � ------------ - �'-`----------------------------•------------•-------------------------•-----------------------------------•--------------•-------------------- Contractor's Name______ _._ _ �------------------------------------------------( ----------------------------------------------- Phone------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other 1 .11Number of living units: --/- Number of bedroomsf Number of baths Lot size __ - _1 -------------------------- Water Supply: Public systemCommunit system Y y ❑ Private ❑ Depth to Water Table Aft. Character of soil to a depth of 3 feet: � t: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay [) Adobe 2?r�Hardpan ❑ Previous Application Made: (If yes,Tate__________ __ ______I No ��New Construction: Yes ❑ No 'FHA/VA: Yes ❑ No Fj-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: ,�,F�./ Distance from nearest well_________________Distance from foundation---------------- Materiaf_______-___--__-______.- /� y •----------------- No. of compartments Size------- ------------------------Liquid depth---- Capacity f ------------- Qisposal Field: Distance from n;rest well__-'��-_-__Distance from foundation__,�,�-------Distance to nearest Ip line__- [� Number of lines__ _ 1_ .-_____-"Length of each line_.��_11________________Width of trench.�- Type of filter material - p "_ e th of filter material-.-sf .---_---Total length_.g �-_--___-- Seepage Pit: Distance to nearest well-_.__-'�--------Distance fro fou anon_____ nG to nearest of line/29._ , ` ,. ®� Number of pits__I/_-- -_---__Lining material___ - Size: Diameter_ . _-_.__Depth�.�/�,�j�,, W Cesspool: Distance from nearest well______________ Distance from foundation-_----.-_--___.__.Lining material__.______-.----- - -------- ------- ❑ Size: Diameter- ----------- -•. --------.Depth------------------ ---------------------------------Liquid Capacity-.--------------------------gals. i Privy: Distance from nearest well_______________________________________________Distance from nearest buiUln g ❑ Distance to nearest lot line...__________ ------ --- - ----------------------- --- Remodeling and/or repairing (desc6be):_______________ 1 -----------------------•----------------------------------- I ---------------------------------------- E ------------------------------------ ---------------------------------------------------------------------------------------------------- ----------------------------------------------- ------ I hereb .certify that I have � y 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)---------- --------------- ------- -- By:--------------------- ----------------------- Title r Contractor) (Plot plan, showing size of lot, locationI of system in rela • to wells, buildings, etc., can be placed on reverse side). F FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED -------- REVIEWED BY { -' DATEf' -- - q BUILDING PERMIT ISSUED----------- ----- -------------------------------------------------- DATE------ _______ -- – QA•TE Alterations and/or recommendations _____ . ------------------------ -_- 15-65` - �. ---------If ----------- -------•----------------------- ------------------------ ----------------- --- -------------------- - FINAL INSPECTIONBY:.-. -. " " . 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 Manteca,California • Tracy,California F.P.CO.