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FOR OFFICE USE: 3 0 APPLICATION FOR SANITATION PERMIT Permit No. __..._ c..... ---------- -------------- ------------- ---------------- - ------__---------------- ---- _..�._. I[Complete.in.Duplicate) ------------------ Date Issued I� /fir This Permit Expires 1 Year From Date Issued Application is hereby made to the San'Joaquin Local Health District for a permit to construct and install th��{prk herei de ed. N This application is made in compliance with County Ordinance No. 549. +� a JOB ADDRESS AND LOCA7kON....___ ___ . , = ----- ---- Phone------------------------=" Owner's Name- = - -------------------------------------- Address_ ' "- --------------- ------------------- Phon _ - _� Asa1Contractor's Nam Installation will serve: ' Residence [ j'Apartmenf House E] Commercial E] Trailer Court ❑ otel ❑ Other ❑ Number of living units: I---- Number of bedrooms Number of baths _/____ Lot,size. �___ �------------------ i Water Supply: Public:system ❑ Community system ❑ Private qj—i pth to Water Table ________ ft. I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date -------------------1 No ❑ New Construction: Yes ❑ No �HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank`or cesspool permitted if public sewer is available within 200 feet.} -------------------- Septic Tank: Distance from nearest well___ _ /__Distance from fo�dation__ ___ __ M e ial__i a No. of compartments----------� Sizerl�l}C' ------=---Liqu depth �5 CapacityPH . # ...� Disposal Field: Distance frominearest-welk4z Distance'from'foundation.__ ._p_--.:._.Distance to.nearest lot line----- __ t /, Number of lines______________________ _ ____ Length of each line__'- -- .-F--___.Width of trench.__ "-----.- ----- ---- Type of filter material--- epth of filter maferial_=__j -�-----Total length-------4___0-------------------------- } Seepage Pit: Distance to Weare t well --____Distance ram foundation ".--.Distance ft -nearest lot line--l-1.5— (t Number of pits-------------- _______Lining material.____.___. ...:-___..Size: Diameter----- 11d_De fh- f P g Lining material- `=---------------------------------- gals. -------------- --;------ Cesspool: Distance from nearest welL________________Distance-from foundatior�"=._.__.:_.__."_- � Liquid Capacity------------------------- F1 '=--------------gals. ❑ Size: Diameter--------=------------------ ----------Depth----------- -------------- r : r E_._-_t_ Distance from nearest building y.� Privy: Distance from nearest well-------------- ---------------- --- -- g--------'-- —------- - --------- ❑ Distance to nearesf lot line- ---- ---------------------------------------------------- ----------- Remodeling and/or repairing (describe)____________ ____ - ----------------=------- -----------------------•-------•------------------ -----•------------- -- f A x� t ---------- -------------------------- ---------.------------------------------------------------- --------"---- --•-••----------------:---------------- - fir` } I. 11 i A'a i .-----_--------------------------- ------------ Ihereby certify that I have prepared this application and that the work-wili't?e done in accordance with San Joaquin Caunty ordinances, St t laws, and rules and regulations of the San Joaquin Local Health District.. +[1 ' ------ Contractor) ` -- - - - ------ ----- ------------- -- - — ,. ...,.� ----------------- --------- ----- -- --- - ---- ---- -- ---- OY= ( - ------- -'------------ -- (Titl@}_-~------------- - - �_... -------------- ------- ------- (Plot plan, showing size of lot, location'of system in relat' n to wells, buil rags, etc., can be placed on reverse side). C � _ G FOR DEPARTMENT USE ONLY CC�� APPLICATION ACCEPTED BY_______________________________ ._V ----------- DATE--------- - ----- ---�--------------------------- --------------------- REVIEWEDBY------------------------------ - --- - ------ -- --------------------------------- --- - DATE-------------------------------------------------- ------ BUILDINGPERMIT ISSUED-------------------------------------------------- ----- -----------------------:------------------_- DATE rT # - .. . Alterations and/or recommendations:------------------- ---------------------------------- ------------------------ ---------------------------------------------------1--------•-------- ------------------------------- . ----------- _ f P _. 1 FINAL INSPECTION BY:...0+ -------------------------- Date -------------- --------- --------------------------- `--�-�--�-� SAN JOAQUIN LOCAL HEALTH DISTRICT .1601 E.Na:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 3M 3•'63 F.P.EO.