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FOR OFFICE USE: -v� , - 0 .._-- - - � � � APPLICATION FOR SANITATION PERMIT Permit No. --------------------------------------------------------- -----------------"--------------------------------------- (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. J08 ADDRESS AND LOCATION__._� �- �� _1a ------------ Owner's Name-- s -------------------------------------------- Phone------------------------•----------- ------•--•--------•----------------- Contractor`s Name----- --- Phone----------------------------------- ------------------- - Installation will serve: Residence 9 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __/___- Number of bedrooms _ _ Number of baths --.-/--- Lot size _57-3 - ---------------------------- Water Supply: Public system 0 Community system ❑ Private ❑ Depth to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe IM Hardpan ❑ Previous Application Made: (lt yes,date______ ___ _______) No 19 New Construction: Yes El No ❑ FHA/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 y__________-----Distance from foundation---------------_y_.Material__._-___-_-__________.________.----___________. ❑ No. of compartments--------------------------Size---------------- -- --Liquid depth--:-'`-----------------Capacity----------------------- Disposal Field: Distance from nearest well.._._'~! Distance from foundation___lf� _.__'__.Disfiance to nearest lot line_____ ---- „ .d ( Number of lines ---------/_.---------------------Length of each line-------�_C'- ..........Width of trench--- - ,-----------------•--- Type of filter material---- iCl --------Depth of filter material____�9-' --------Total length__._410----------------------------- �,. Seepage Pit: Distance to nearest well_____________________Distance from foundation______..-_,__'_.__.Distance to nearest loft line______.._--.__.._ ❑ Number of pits----------------------Lining material---------- ------------Size: Diameter---------------------- Depth- - ----------------------------- k ---------------------------- 6 Cesspool: Distance from nearest well-----------------Distance from foundation.-------------- material__.--__ _-___-_______. ❑ Size: Diameter------------------- ---Depth------------------- ---------------Liquid Capacity---------------------- -------------- Privy:' -------------------- gals. --------------- ----------------- 1 Privy: Distance from nearest well------------------ '--------------------------Distance from nearest building__F_--_____________________- _._____--- ❑ Distance to nearest lot line---------------=-----' ------------------------------------- ---------- ----------------------------------------------------------------- t P � t fRemodeling and/or repairing (describe)---------dZ_+ -------- -------------------------------------------------------- ` ------------------------------ ---------•----------•------------------------------------------------------•------ ` 3 --------------------------------------- r ------------------------------ 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 regulations of the San Joaquin;Local Health District. (Signed)____ (Owner and/or Contractor) : ;. -------------tem m relation to wells----------- -------------------(Title)------------------ ------------------- -----___1------- (Plot plan, showing size of lot, location of.sys buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY f APPLICATION ACCEPTED BY_-- -� �Q..-. __' _ '" - --------•__-- DATE-----�r_�----_�-Cl-------------- REVIEWEDBY------------------------------------------------------ ------------ ------------ ------------------------ DATE ° BUILDINGPERMIT ISSUED-------------------------------------r .------ - -------------- - ---------------------- --------- DATE------------------;: AltPaatioDns and—/or recommendations:-------------- --- ---------------------- ------------------------------------------------------ ----------------- -- ------------•-------------- � fJt= - -.-- .� - " ¢ -------------------------------------------------- -----•-- ------------ ----------------- - -----------------------------•------------�' ---------------------------------------------------------------- -------------------------- = - ------ `..-- cE-t° Date------ FINAL INSPECTION BY: / _v�.- j t 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 tr E5 9 R6vI5EP 0-59 3M 3-'63 F.A.C..