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FOR OFFIC U E: - --- --- - - ---- ------- ' -- - �-`�-�-- Permit No. - --••---...------•- APPLICATION FOR SANITATION PERMIT ------ ---- ---------------- (Complete in Duplicate) Date Issued ----- -- -------- ---------------------- 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 the work herein described, This application is made in compliance with County Ordinance No. 549. t ! ----_---------•------------------•-- JOB ADDRESS AND LO ON .-6- - --------- ----------------- "------- Owner's Na2(�_-.- '!1---------------------- -- ------------- -----"--- Phone-.....---------------------------- - Address.. ---- ------------------- Contractor's Name--- - _..._------••-------------------------------- - - ----------- Phone----•------.-_-------•--------_.. [- Apartment House ElCommercial ❑ Trailer Cour# ❑ Motel ❑ Other ❑ Installation will serve: Residence -� X _'sem ----"------- Number of living units: -1----- Number of bedrooms --I---- Number of baths .__. --- Lot size __-_S_---____-m--------------------------•- Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table 4P ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe(Zr-Hardpan ❑ Previous Application Made: (if yes,date--------------------) No ID' New Construction:-Yes No E] FHA/VA: Yes I-] 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 Distancefrom�foundation---l-9----• Material---- " -'U--a--j -- -- --- No. of compartments-------- . 2 --- " & " Li uid de th__._ Capacity-- from � Ca adty-- from foundation.la.r--".--_""..Distance to nearest lot line"- ._ _-........ Disp1�osal Field: Distance from nearest well.,1�:(_----Distance Number of lines.-----------r ---Length of each line-----�/�------------------Width of trench.---.---- - ----------------- �t Type of filter Depth of filter material--1 _�`--_-----"-.Total length--"".............jo-f------"._--"•.. i See a e Pit: Distance to nearesfi well""' "` .--------Distance from foundation-_1.o-...___-"-_.Distance to nearest lot line--.- Number of pifis--_-___-I------------Lining material-:_TK�t"--------Size: Diameter---3.?.------------.Depth-----'A.+5 ---•---•--------• Cesspool: Distance from nearest well-------------_-Distance from foundation---------------- - ning Capacity l __-gals. ❑ Size: Diameter--------------------------------------Depth----•---------------------------------------------- Liquid ------- ----------- Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.---------------------------•------------- ❑ Distance to nearest lot line-----------------------------------------------------------�---c ---------------� -------•-•----------------. ------------------ Remodeling and/or repairing •------•--------------------------- �. e I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County r ordinances. State laws, and rules and regulati s of he San Joaquin Local Health District. Si ned -------------------------------------{Owner and/or Contractor) By:--•-------------- --------------------------------------------(Title)---- --------------------------------------- ------------ -------------------- ------ (Plot plan, showing size of lot, !oc on of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTEDBY - " c. / C -- ---------------------------- DATE •------------------------- REVIEWED BY----------------- ------------- -------- --- ----------- ----------- ----------- ------------ ------------------ --- -- DATE----------------------------------------------------------- BUILDING PERMIT ISSUED--------------------------------------------------------------___---------------------------------- DATE------ Alterations and/or recommendations:------------------------- ---------------------------------------------------------------------------- A ---•--- ------•-•----- I f-----•--'-- --- ----•------•-- --------------------------- ------------------------------- --• I .- INSPECTION BY:. .:._. --.-. i�2 '� Date"._1. --------------- FINAL SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California , `Manteca,California Tracy,California E6.9 REVIEEC E-59 r.P.CO.1M"o