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' A ICATION FOR SANITATION PERMr,T Permit No. -. -------------------------------------------------------- (Complete in Duplicate) '^ ________________ This Permit Ex ires l Year From Date Issued Date Issued _-. Application is hereby made to tyre 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. / '� �/ J k3 3 JOB ADDRESS AND 1OCATION_/ Owner's Name----------------- 'j,� '- ---------------------------------------------------- - Phone 5 3 7 Address �w --------- Contractor's-� Contractor's Name--------- -- �� ------- ------ Phone_/_- ---___.��C�-----•- Installation will serve: Residence Nj-_A�partment House ❑ Commercial ❑ Trailer Court ❑ //Motel C] Other ❑ i Number of living units:/----- Number of bedrooms ._.3_ Number of baths _jz:,2_ Lot size ----1!_O!P____ ___________________ _______________ Water Supply: Public system ❑ Community system ❑ Private M4epth to Water Table ft. j Character of soil to a depth of 3 feet: Sand Gravel E] San y Loam ❑ Clay Loam E] Clay ❑ .Adobe[Hardpan ❑ E]t.= Previous Application Made. (If yes,date____________________) No [ New Construction: Yes ❑ No �HA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ank; Distance from nearest well________________Distance from foundation-------------------.Material-____.________.______.__..-_________._.______._. INo. of comepartments------------- ------------Size--------------------------------Liquid depth--------------------------:Capacity------------- y, t Disposal Field: Distance from nearest well_5. _.__Distance from foundation.__3.d.____.Dista' nce to nearest lot line----------------- i Number of lines_________-_�__ -/?40.- Length of each line___, r _ ___� of trench._-_. _l_ Type of filter material__-- __ �}6-yDepth of filter material--- -___9-----------Total length___ _. _a______________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- material ----------------Size: Diameter-------------- --------Depth❑ Humber of pits----------------------Lmtng mate p --- iCesspool: Distance from nearest well-----------------Distance from foundation.----------------- --Lining material_____________________________________ { ,� ❑ ---- ----------------Liquid Capacity---------------------------- Size: Diame;ter----- ----------- ---------------Depth_ -------------------- \ Privy: Distance from nearest well-------------------------------------------------Distance from nearest building--------------------------------------- E] Distance to nearest lot line - -----------------------------------------------------------------•-------------------------------•---•-----------------------------4- 7. --------------- Remodeling and/or repairing (describe)-------------------------------------------------------•-- ----------------•-•------------------ •--------------•------------•---------------------- -------- ----------------------------------------------------- -------------- .. ------------•------ �l --- - OF.,- ----------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, 35tlaws, and rules and reg tions of the San J quin Local Health District. Contrac(Signed) --------- ----------------- - ---------- --- ----- ----- --------------------------------------- {O er and/or tor) �. BY-----------------------------------�- -- ----------- - ----- ---------------------------(Title)- --- --------�� -------- -------------- (Plot plan, showing size of lot, Vocation of system in relation we Is, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B)'------------------------------------------------------------ - --- ----- ATE------- --- ; -- : ------------------------------- ---- --------------- REVIEWED BY----------------------------------- - ------ - ----- - .. BUILDING PERMIT ISSUED TE -------------------------------------------------- Alterations and/or recommendations____________________________________-------------------- - --------------------------------------------------------- --------------------------------------------------------------------------- --------------------------------------•--------- ------------------------------•------------------------------------------------------------------------------ -------------- ------------ ----------- -------------------•------------ --------------------------------------------- --- --------------------------------- ------ ---------•---- ------ - ----------- er ----1------- � Date------- ' FINAL INSPECTION BY: - ---------- -------- -----------------=-•----------- - ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.flasellon Avr. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California � � F.P.CC.