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vrrllt � i— ----------- .+- _ -------- ------------------------------ APPLICATION FOR SANITATION PERMIT Permit No. .;2YO7 G ----------------------- -------- ----- --------- ---- (Complete in Duplicate) -- -------------------------------- ----------- This Permit Expires 1 Year From Date Issued 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. JOB ADDRESS AND LO�TI N-_ / - ------------------------------------------ Owner's Name -------------- ------ Phone - - ------ ---------------- ------------- -------- Address--------•---- --------1-�-------- - - - -------------------- ------------------------------ ---------- • -------•-----------------------------------------•-------------•--------- Contractor's Name_________________ _ Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Cour} ❑ Motel ❑ Other Number of living units: /__ Number of bedrooms f---- Number of baths __/_ Lot size -----Sd ❑ Water Supply: Public system ©�community system ❑ Private ❑ Depth to Water Table s�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_ ----- ---- No R--*New Construction: Yes ❑ No [[rH_A/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) tP ank: Distance from nearest well-----------------Distance from foundation---------------- ....Material---------------------------------------No. of compartments__. - -.--Size------------------------------Liquid depth------------ ---------Capacity spa Field: Distance from nearest wellD ------ _____ romounaion___.___-_________._.Distance \Vt to nearest lot line_____________._-- Number of lines-----------------------------------Length of each line------------------ -----------.Width of trench------------------------- -- --- Type of filter material-------------------------Depth of filter material-----------------------Total length------------------_----------- --------- 5eepage t: Distance to nearest welt-_Distance from foundation__,14-_____.Distance to nearest lot line....•5_----I_-- Number of pits___--/----_.--- Lining material__�y O-_C. .___.Size: Diameter....,3.3__" - I � - ---Depth----A�47------------------- Cesspool: Distance from nearest well __Distance from foundation---.--------------..Lining material-------------------. Size: Diameter---- --------- -- -------- -----Depth-------- ------------------------------------------Liquid Privy: Distance from nearest well. Capacity---------- ---------- -- __gals. Distance to nearest lot line❑ __ _________________________ __Distance from nearest building - ---------------------------------------__ _______----_ ---------------------------------------------- Remodeling ----- Remodeling and/or repairing (describe)_________________________________ -------------------------- ------- ------------------------- -------------- - ------------------------------------------------------------------ -------------- -------------------------- ------------------------------------------------------------------ ------------------------------------------------------ ------------------------------- -- I hereby certify that I have prepared this application and that +he work will be done in accordance with San Joaquin County ordinances, St to laws, and rules and r gulations of the San Joaquin Local Health District. r (Signed)- ' -- -- - --- --------- By: - ------------ ---------- . - ------ (Owner and/or Contractor) By:--------------------------------------- ----•-------- - (Title)--- (Plot wn plan, showing size of lot, location of system in relation +o wet , buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY `. ------ ------ / DATE 6 ---------------------- VIEWED BY---------- ----- -- - DATE - - ----------------------------- --- - ----- -------------------•---- ---- 1LD1NG PERMIT ISSUED--------------------- _ -- ----------------.......... Alterations and/or recommendations:.__ . ._ DATE__ _._------- - - ------ ---- -------------------------------- FINAL INSPECTION BY:..1l_L.!. �iLl_� Date- --- �r SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.