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` K UI-HCE USE: ----------------------- --------------------- --------- APPLICATION FOR SANITATION PERMIT Permit No. ._1 �- , --------------- ---------------------------------------- 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 Count Ordin ce No. 549 JOB ADDRE S A _ TI N__..---�] -- --- - ------------------ --------------------- -- ------- --- --------- ---�--- ------------ ------ Phone-=-------------------- -------------------------- ---- - Addres -- -------•!;__ -` Contractor's Nam ---- _---- ho-- -�—--- -�,��. � -- - ------- -- -- Installation will serve: ResidenceApartment House Commercial ❑ Trailer Court E] Motel ❑ Other ElNumber of living units: _..�_. Number of bedrooms -__.---- mber of baths - _._.. Lot size Water Supply: Public system ❑ Community system Private ❑ Depth to ter Table --_--.- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loaay E] Adobe❑ Hardpan ❑ _ Previous Application Made: (If yes,date------------ j�No--------] No ❑ New Construction: Yes ❑ FHA/VA: Yes ❑ No ❑ I TYPE OF. INSTALLATION AND SPECIFICATIONS: (No septic tank`.or'cesspool permitted if`ubJic. wee is aveilable`within-200 feet:) Se ti ank: Distance from ne7 11 arest well..- ___..DTs fro 'foul a (/ Materiae__.. ~ c/�f — 1 fj ��+ No. of compartments__--"�.- Si ' -Liquid depth___ / fTG/ --------- / •- Capacity- -- Dispeld: Distance from n st well -----Distance from foundat- n_- C1- ...Di Lance to nearest I lid Number of lines Length of each lind-.�__-- i dth of trench--- - ---------------- Type of fitter ma eria -� .....Depth of filter mat ial-_. --------------Total length--- lD'_ ._ - � Seepage Pit: Distance to nearest well,---------------------Distance from foundation--------------------Distance to nearest lot line-------------_--- ❑ Number of pits---------------------Lining material_----------------------Size: Diameter--------------------------- --------Depth-----------.---•- ---------------- Cesspool: Distance from nearest well _ -__._Distance from foundation- -------------- Lining material--_---------------------------------- ❑ Size: Diameter 7I Depth--------------------------------- ----- -------Liquid Capacity----------------------------gals, I! Privy: Distance from nearest well------------ __.Distance from nearest buiidin + Distance to nearest lot line------ _________-_-__._ ---------------------------------------- El Distance 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, a ws nd rules a )regulations of.the San Joa 'n Local Health District. (Signed)--------------- ------------- - '. p ------- raj r Con R _ - �� tract ----- "------- -- title ------- (Plot or_� i = ( = . } — plan, showing size of lot, location of system in relation t wells, buildings etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY t APPLICATION ACCEPTED BY------- - .c-.�---------------------- ------------------------------- ---------- DATE------- REVIEWED BY ----- ----- DATE-- UILDlNG PERMIT ISSUED --------------------- ----------------------------------------------------------- DATE----- -- ----•------ •- A terations and/or recommendations- ---------- - ----------- ---------------- --------------------------------------------------- FINAL INSPECTION B Date -------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harellon Ave, t 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi, California Manteca,California Tracy,California -h•.+y F.P.0 q,