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f_UX C7r1-ICt USE: I� -_---------- --------------------------------------------- ----------- ------------------ ------- -- - - _________________________________ _-----___------------ APPLICATION FOR SANITATION PERMIT Permit No. 1 - r ' -------------"--- --------- --------- ----- ------------ (Complete in Duplicate) I ---- This Permit Expires 1 Year From Date Issued Date Issued _ - � { Application is hereby made to the San Joaquin Local Health District for a permr�#to.construct and install the work hereinesc� ed. [ This application is made in complianc/e with County Ordinance No. 549. Ef I JOB ADDRESS A LOCATION_/ _ qr � e Owner's Name _ ------------ Phone Address _ •__ 1__ --_--•---- Contractor's Name = ----- -------- --- Phone-------------- Installation will serve: Residence X Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel El Other ❑ Number of living units: _-.J Number of bedrooms__ Number o baths _ Lot size _1`1_______________ ___ Water Supply: YPublic system ❑ Community system ❑ Private umber to Wafter Table -__._ ft. OT th of 3 Character of soil to a de fel: p i Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe E] Hardpan ❑ � _____ Previous Application Made: (If yes,date....................a No El Construc.tion: Ye;� No ❑ FHA/VA: Yes ❑ No ❑ w--r—T-YPE-^OF INSTALLATION-AND-SPECIFICATIONS:.,.•�- _ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) t Se t' nk: Distance from nearest well ______________"-Distance from foundation_- -______,______MatBrief-----_- _ __-----_-__----------- No. of compartments------ ------------------Size-------------- ---- -•-------Liquid depth------------------------ Capacity - p /� ce from foundation____/__?_._.__.._.Distance to nearest lof line_-____.. is vsal field: Distance from nearest well_�P-____._ Number of lines!.._.___?- Len th of�each line-----/.4_Q-!_- •=:Width of tranch istan 9 Type of filter material____ ,__. _ - r Yp [ � - ---Depfih of file material_-��-••~---�T�o_ata#Llength---�p-U--- --------------------j � 1 Seepage Pit: Distance to nearest well-_.___.__-___._._____Distance from,foundation____________________Qistance to nearest lot line_______.____-__._ .. _I ❑ Number of pits.-1------------------Lining material_.------------ a__._.Size: Diameter------_---------------Depth-!...�1------------------------ Cesspool: Distance from nearest well-------------____Distance from foundation--------------------Lining material__._-�_?___ #.._______--____-_____ ❑ Size: Diameter-----------------------------------.Depth------- ----------- -----I t! '�� -----------------Liquid Capacity ___-- gals. 1 ( Privy: Distance nearest rest well_________________________.________.__.___. Distance from nearest building Distance to nearest lot ine------ -- ------------------------------- Remodelin9 and/or re a+ring {descriia}-- - " { 1 - - - ---- ------------------- - - ----� � �_ ------�---�_.i �-------------- 3 --------------------------------------- -------- ----------- ------- ` .. ---- ------- p-- - ------------------------------------------------------------- ---------------- ---------- l --------------------------------------- ------------------ ---------------------------------------------------I #. ,. f I hereby certify that I have prepared this application and that the work will 6e done in accordance with San Joaquin County~ ordinances, State la , d rules and regulations of the San Joaquin Lacal HealthFDistrict. (Signed)- --------- -- --- ..�.P. •; ----- -- -- sInd/or Contractor) 'fry - ( . _.. By - 1 - - ----------------------------------- (Plot plan, showing size of lot, location of system in relation o wells, buildings, etc; can be placed•on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_,-,-' DATE------------------,--------------- -- REVIEWED BY BUILDING PERMIT - --------r-------- -- --------------------- - ------------------- -----_ DATE-------- -------- ----•- -�------l- ISSUED - I i �. Alterations and/or recommendations:. ------------------- ---------------------- -------I-------------------------------------------1------ ---------------------------•-------------------------------------------•-------- l ---------------- ------------------ t 1 --------------------------------------- ---------- ------- ----------------- --------•----" F --------------------- •--------- -- ---"-+-------------------------------- T . FINAL INSPECTION BY:--- °---_--- --•-- +� -------------- Date-- / _r--�_. 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 F.P.0 A. t