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FOR OFFICE USE: --- --------------------- --------------------------------- -------- 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 here-in described. This application is made in compliance with County Ordinance No. 549. t'a .-.' � - A JOB ADDRESS A LOCATION-- --------- ----------------f - 1 , -�C'• Owner's Name---P — '"� ---------------------------------- -- -- ` y Phone------------------------------------ Address_ f s' ' -----------• --------------------------------------------•------------------------------------- ---------------- Contractor's Name--o";--- -------------------------------------------------------------------------------------------------------- ---------------- Phone...................._--•---------- Installation will serve: Residence [j Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:I------ Number of bedrooms -------- Number of baths ----- Lot size _�'e7_%4e------------------------------------------ Water Supply: Public system ❑ 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 [3 Hardpan E] Previous Application Made: (If yes,date___________________) No ❑ New Construction: Yes ❑ 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-----------------Distance from foundation-------------------Material---------_______---------_-------------..------- ❑ No. of compartments--------------------- ----Size--------------------------------Liquid depth--------- ------ -------.Capacity----------------------- Disposal Field: Distance from nearest well--------------- _Distance from foundation--------------------Distance to nearest lot line_-----------_---. 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_JPV*:t"-------Distance from foundation--'VO f___-----.Distance to nearest lot line_---------- Number of pits---- ----------------Lining materia -----------Size: Diameter.....3w).`.--.._...---Depth_a;�rte--___-------_.-. fir. Cesspool: Distance from nearest well-----------------Distance from foundation------------------- Lining material----------- -------------------------- F1 ___-------.--- -.❑ Size: Diameter.-------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building -------------------------- -_._-. ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------- ------------------- 1 � � Remode4ing and/or repairing (describe]----- -- --------------�'� ^----�--------=----••-• ---------------- '/ / -------------------------------------------------- gk ------------------------------------------------------------------------------------------------------------------------------------------------------------------------ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County . V ordinan , State laws and rules r ulations of the San Joaquin Local Health District. Y (SSi ne� ------------------------- -------------------- ------------------- (Owner and/.Contractor) igned)--- ---------------- 4 )-- w.�BY --------------------`- -_-=-----------------------=-------------------"------------- ---------------------- ::_ (Title)----------- -.:.------r- - --------..: --------- --- C (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 APPLICATIONACCEPTED•BY--.✓.�"' c �t ------------------ ---------------------------------------------- DATE. ----------- ------------ ----- --------------------- k REVIEWEDBY.-------------------------------------------- ---------------------------------------- -------------------------------------- DATE------------------ ---------------------------------------- BUILDINGPERMIT ISSUED------------- -------------------- ------------------------------------------------•------- ---------- DATE----- ------------------------------------------------------ Alterations and/or recommendations------ - ----------------------- ----- ---------------------------------------------------------•-------------------•-----------•-------------------•----------- -•------------------------------- --------------------- .-- ------- --------- ------------------------ ----------------------- ------- ------------------------ -------------------------------------------------------- ----------------------------------------------------------------------------- ---------------------- - ---------------------------- FINAL INSPECTION BY:- r - -r --------- -------------- Date ' =s ---------- ------------------ ---- ----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Rod[,California Manteca,California Tracy,California F.P-c c. ;� `