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FOR OFFICE USE: ------------------------------------ -------- APPLICATION FOR SANITATION PERMIT Permit No. -------------------- ---- ---- -------- ---- -- (Complete in Duplicate) ------------ ----- ---------------------------------- this Permit Ex fres 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. i This application is made in compliance with County Ordinance No. 549.. y J08 ADDRESS AND LOCATION------- ------------ j - Owner's Name____.__-- Address-----------------------•--•-- l' --------------------------------------------------- • s .. --- --------------- -- ----•-----•-------•-r Contractor's Name---------- ---------------- Phone. Installation will serve: Residence 2§"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --.1r_.- Number of bedrooms __-�F"_ Number of baths I---- Lot size -------� Water Supply: Public system ❑ Community system ❑ Private 8 Depth to Water Table Gi& ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel FI Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date____________________] No Ir New Construction: Yes §0' No ❑ FHA/VA: Yes ❑ No P!r—" TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available-within 200 feet.]+— ` + /L Septic Tank: Distance from nearest well--- Q�f_Distance from foundation__._---(I__t.- Material_...__. -_ Rr No. of compartments-----.C� ------- Size -Y� Liquid depth--------Y-�----------Capacity----- - - Dispo�al Field: Distance from nearest well_.-�---1-.-Distance from foundation-__ ,Distance to nearest lot lin e-___ ..-_- 4 L f � Number of lines--------------- - .. -__--- -Length of each lin ___ _ __ -- ---.�0._.Width of trench._ _. . _ Type of filter material. -Depth of filter material-_.�e'_----- g ----�-Total length-----� •----�----•------•----- Seepage Pit: Distance to nearest well----------------------Distance from tfoundation-------------------Distance to nearest lot line_.__.-___._____ ❑ Number of pits----------------------Lining material------ ------- -Size: Diameter----------------- -----Dept h-.--------------------------- Cesspool: Distance from nearest well------------------- from foundation.--__._..._. __... Lining material__________________________._ _- t ------ ❑ Size: Diameter -- ---------------Depth----:-------- ----:---- --- -------- - ----Liquid Capacity----------------------------gals. Privy: Distance from nearest well -___-_-____-------------_----------------_____Distance from nearest building------------- _------_-.---_ - ❑ Distance to nearest lot line--------------------- 1 ----------- Remodeling and/or repairing (describe):-- - t _ ------- _ _V�-t._ -- 69! Wv+---------- -- ------_•----------------- ----------------- -----------------------•----------------------------------------------------------------_--------------------------------------------------------------•---------------------------------------------------------------- -----------------------------------------------------e.Lc----____-_-__----_-_„---_-_-_._------.--------_-__.-__-----__--_I---_---__-____--___--_-----._-_----_-._._-_____---___--__---__-_-_-_--_--_--.-_-_.__---._-__.-_-- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count/ ordinances, Sta laws, a rules and re ulations of the San Joaquin Local Health District. (Signed -- E� i ------------------------ - .-- --- -------[Owner and/a By:---------------------------------------------------------- - --- Title (Pl of plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side]. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-.-- ---------- ---------------- ------------ DATE--------- � �r' ------ fEWED BY-----. ---------------------------------- DATE------ - - UILDING PERMIT ISSUED-------------------------------------------------------------- -----. DATE Alterations and/or recommendations:-__................... . . ------------------ ---- ----- --------- - , - -------------- ------------------------- - ------------- FINAL INSPECTION BY:......---...... Date.-.- L� _. - -�� ------- `�- -----�----- -- ___-.- 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