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'FOR OFFICE USE: I -------------- ----------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ..�. --------------------------------------------------------- (Complete in Duplicate) D- -------------------------- This Permit Ex ires 1 Year From Date Issued Data Issued --- AA 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 compliaAz nce 3 ce with County Ordinance No. 549. , F��'(~ l rt'{? � JOB ADDRESS AND LOC TION.-- • __�____•- � • � Owner's Name-------- ........... CV! ...... -----------------------•------------ ----•----------- Ph ... Address --------------••------------•--------------------------------••---- Contractor's Name --------------•---•----------------•--•---- ..................Phone....................... Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Niptel ❑ Other ❑ Number of living units: __j____ Number of'bedrooms _2k--- Number of baths _ . Lot size ----1161. ................................ Water Supply: Public system ❑ Community system ❑ Frivate n Depth to Water Table �5 ft. Character of soil to a depth of 3 feet: Sand ❑, Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan Previous Application Made: {If yes,date----------—------- . NoA New Construction: YesX No 0 FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well-----------------Di a'nce from foundation______._..__.._..__.Material--_-_-.-_______._____'_.......................... kro- ro ElNo. of compartments....----------------------Size........- .----:.---------Liquid depth-------------------___Capacity.-----._..._....__._... Disposal Field: Distance from nearest well_________________Distance from foundation--------------------Distance to nearest lot line----------------- 71 Number of lines___________________________________Length of each line-----------------------------.Width of trench------------.................. ..... Type of filter material_________________________Depth of filter material-----------------------Total length_.__._._________-----------------�___.__ Seepage Pit: Distance to nearest well----;l�_ _'----Distance from oundation__._ .tZ__ ^...Distance to nearest lot line..t .______.. Number of pits____-1_________ ��,- Lining materia�t _� Size: Diameter____.! ^r.____Depth__- ______ rq„ Cesspool: Distance from nearest well..----_--------Distance from foundation--------------.-----Lining material...-.-.._.._-__.__-__________.__.__-- I] Size: Diameter--------------------------------------Depth------------ - t---------------�---------------------Liquid Capacity---------------------•-_---gals, Privy. Distance from nearest well______-----------------_------------------------- Distance from nearest building............._____________-_____-...___._. Distance to nearest lot line- ------------------------------ �__________________ --- ---•------------ - Remodeling and/or repairing (describe):.- 3 -•• .- - ...---- ••............................ - - ► .1 ' ---•------------------------------------------------------- ----_---------------•---------------- ----•---------------- ----•---••----• -----------------------------------•------------•--•-----------------------------------------------------------------•---------------------•-----. I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and egulations of the San Joaquin Local Health District. (Signed)• 1 .. ............... -------------------- ---._......-----------------------------4-----•-•----------------(Owner and/or Contractor) ...Title (Plot 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 �� = REVIEWEDBY---------------------------------------------- ------------------------------------------------------------------------------- DATE.-_.-------•-•---------------------------------------------- BUILDINGPERMIT ISSUED-_-------------------------------------------------------.----------------------------------------- DATE.....--- ---•-••--------•-•-------------------------------- Alterations and/or recommendations:-------••---------------------- -----------•-----------------........-------------------------------------------------...._.--.......................... --------------------•-------------.-.------------- ---------------------- -------------------•-•-----•---------------•--------------------•-----------------------------------•-- 4FINAL INSPECTION BY:- Date--- '. � �1r -------------------- - -------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 Wort Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 51 REVISED 8-S9 2M a-61 AUA9 -