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FOR OFFICE USE: f --------------------------- --------------------------- - APPLICATION FOR SANITATION PERMIT �� _�1 ------ --------- ---------- ---------- ------------ Permit No ----- ---• --- = (Complete .in Duplicate) This Permit Expires 1 Year From Date Issued Date Issued------ App{kation is.hereby made to the San Joaquin Local Health Districtfor a permit to constr ct and in all the work herein described. r This applicatiori is made in compliance. with County_Ordinance.No. 5�97"'_. •""''-` eneQfi �.� JOB ADDRESS A ; O , TION _ _ ------ --- --- -- - Owner's Name-- - 'E, * �.. ` ------------------------ Contractor's Nai - Phone . --------- ----—--....__�1.._. --- -- -- ----- -- ---- �►.J - ---•--•-------------- ------------•-- ' -- ---------------- --------------------------------------- Phone..------------ -•------ ------ Installation will serve: ' Residence ° F[Apartment House Commercial ❑ ITrailer Court ❑ Motel ❑ Other ❑ Number of living units: _".!_-- Number of bedrooms " - Number baths _1 '- - - _ ----- Lot size --- ---------------- I ---• ------------------- Water Supply: #Public system ❑ Community system.❑ Private . Depth'to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ GraS , el,E]Sandy Loam ❑! Clay Loam ❑ Clay [Adobe ❑ Hardpan E]Previous.Application Made: (If yes,.plate."".- ) Ndd o ❑ Jr NewConstruction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE SOF INSTALLATION -ANDSPECIFICATIONS: 'j, -_3 ` _ * [Noseptic-tank or.cesspool-permitted if-public-sewer_is-available within 200 feet. Septi 'ankh ' Distance from nearest well--_""�4_---" R ` r,- Distance from foundqtiom___-L_Q ^• x . N of compartmenfis ------- Size_ -�j-.� Liquid depth--# Ca acit -- aG P Y Dispos Field: I Distance from nearest well....rQ- --".Distance from foundation----- P-"_".""".Distance to nearest lot lin Number of lines-"k"_--"""_/ Length of each line--- G -- ---------------Width of trench---- �A r - Type.,of filter.materiaL Depth of filter material---_.1W-�-_°_---Total length-.- d__ t t --------------------------- f i Seep` Pit: Distance to nearest well----1p0__----------Dafiance from undation-.""r V"_ Distance'to nearest lot he""- Number of pits.__--- ------------Lining material--�------Size: Diameter._-_--1 �� - ---.Depth-------- E Cesspool:. Distance from nearest well---------------- Distance from foundation---------- Lining materia!------------------------------------- El i `s Size: Diameter----# '-----------------------------Depth-------------- --------- .-Liquid Capacity- --------------------------gals. t Privy:_ � ,r. Distance from nearest well ------- Distance from nearest building ❑ f . "I I Distance to nearest lot line.......... ---- Remodelin9:-and/or repairing [descrilje):----__-------------------------------- ------------------------------------------------------------------------ -------------------------------- ----- I - ------------------------------ --------"------------------------------------------ -------------- --------------------- =-------------------- ----------•-----•---- ---I- - I hereby certify that I have prepared this application and that th 90rk will be done'in accordance with San Joaquin County 1� ordinances, Stalin and rules ands gula+ions of + an Joaquin cal Health District. (Signed)--------- �. = rContractor) --r..- ---- --- ------[Title) -- o (Plot plan, showing size of lot, location of Sys em in relation to wells, b gs, etc., can be placed on reverse side). t' FOR DEPARTMENT USE ONLY' APPLICATION ACCEPTED BY-- - -- ----------- --- ----------- -------------------- ----- ------------- - ----------- - DATE-1/-0-_!�-_� --------------------------------- REVIEWED.BY _ ,: _ :: :, ::__- ------------------ :-_- DATE BUILDING PERMIT ISSUED - __=- - - T i,._-_ .......................................... -----------------------'-----=_--- DATE.'c---------------------------------------------------- I .. _".... "-,_ " Alterations and/or recommendations------- ------r ___- -"" ---" - ---- ----------•----------- } 1 . ' =----------- ----- --- ------- --------- --------------------------------------------- - ------------------------------------------ ------ ----------- ------------------------------------------------------- FINAL INSPECTION BY: - -- - ----------------- Date-/ --� r- �--3 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Maxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy, California , ES 9 REVISED 3-S9 3M 3"•63 F.P.CO. r