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vrt vrrlt..c VJt: ----- ---------- a- � 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 Son 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 SS l: JOB ADDRESS AND LOG TION_..___-0?/_ j- _-__ -- ----------•----------------------------- Owner's Name Address----------- -_ ------------------- -- -- --- -------------------------------------- Phone------------------------ • -----•---- Contractor's Name_________________ ------•----------- --•-------------•-------•- �e_:�_ --------------------:�-------------------------------------------- Phone. Installation will serve: Residence �,partment House El Commercial :❑ Trailer Court ❑ Motel ❑ Other Number of livingunits: _ P ❑ F---- Number of bedrooms _.�._ Number of baths-__!`._ Lot sizeik_ Water Supply: Public system V11"Community system E] Private E] Depth to Water Table f} Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe M I'Mardpan [❑ Previous Application Made: llfyes,date---.----------------1 No &P" New Construction: Yes ❑ No 91— FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) iISe Septic Tank:,,, Distance from nearest well-____--_______-Distance from foundation_^---_-------------Material _._._______.__._._------_"- l16W No. of compartments-------------------- ----Size--------------------------------Liquid depth-------------------- CapacitY ------------------ Dispog'al Fiejd: Distance from nearest weil-----------------Distance from foundation--------------------Distance to nearest lot line___._____________ Number of lines-----------------------------------Length of each line------------------------------Width of trench-.------------.-------"-- T e of filter material_____________ ___ YP... - --------Depth of filter material-----------------------Total length---- ------------ --------- -------------- r Seepage Pit: Disfance to nearest well------ ' Distance fr m foundation____7p------.Distance to nearest lot iine./�--�--- I�� Number of Pits----- --------------Liningmaterial _ - . ��G.-Size: Diameter__&_?_----------Depth_�,'�-.`-`A,_-1 /��_ Cesspool: Distance from nearest wellDisfance from foundation---._------------" dining material........ --________.__-- -------------- ❑ 1 Sze: Dia meter- }-------- ------------- ----Depth---------------- ------------------ Liquid Capacity gals. • -- Privy: Distance from nearest well__________________------------------------------------------------..___Distance from nearesf-buildin g : - Distance to nearest lot line ,r r Remodeling and/or repairing (describe)-------------------��,�• - - �� r. I ------------------------------------------------------------------------ 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 and regulations of the San Joaquin Local Health District. (Signed) By:----------------------------------719_dr0 or ---- (Tale}.-- r -- ---- -- ---------- ----------- - (Plot plan, showing size of lot, locatiot'I of system in rel ' n to wells, buildings, etc., can be placed on reverse side). e R DEPARTMENT USE ONLY APPLICATION ACCEPTED BY... DATE._ r REVIEWED BY------------- - ----------------- -j --- ----------------------------- -- - -- = ---------- DATE ¢" BUILDING PERMIT ISS�JED_____------- -------- - AT- ----------- ------ ---------- ------------ ---- - ---- -- ----------------- Alterations and/or recommendations:__.___ .____._ 4__ ------------------------------------- ------------ I ------------- ----------------------------------------------------------- - ------------------------------------- 1. --------------------- ------------------------------------ ----------- --------- - •------------- ----------- FINAL INSPECTION BY:------- -(/"-- - ---------------------------- ----------- Date ( p� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th street Stockton,California Lodi, Califdrnia Manteca,California Tracy,California F.p,CO.