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APF"uATION FOR SANITATION PERM Permit No. _ _ ,~�.?...... (Complete in Duplicate) i/� //S-� Date Issued __- zl--_ _-- 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 �eescribed. iThis application is made in compliance with County Ordina ce No ft9. `V� i 1p JOB ADDRESS AND L CATI �--- - ----- -------- °--------------------------------------------------••----:_.._..------------ 4 Owner's Name-- 1 -- •••- . •--•- Phone----•----------------------•-------- Address----------- A.. ------- ------------------ Contractor's Name......................... �._ ................................... ----------------------------..............-. Phone-------••-------.:-.-..----------•- Installation will serve: Residence !U Apartment Hous Commercial [irfrailer Court ❑ Motel .C] Other ❑ Number of living units: _-_ N"Umber of edrooms __`er.�Number of baths ---/__ Lot size ......................... Water Supply: Public-system [Community system ❑ Private ❑ Depth to Water Table .-gA`ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe E,: Hardpan ❑ Previous Application Made: Yes ❑ No P90"New Construction: Yes RrNo ❑ FHA/VA: Yes ❑ No [g— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public.sewer is available within 200 feet.) // Septic TaDistance from nearest well------- Distance froim, Xfoundation------- ya�tejriial--.._._ ►--- . ._• _____ _____ No. of compartments-- -- -----------------Size--�-�- Liquid de .th.----- ------.---- OCa acitY-- - Q .--.-- _ Disposal Field: Distance from nearest well..._._._"-`__._Distance from foundation._._.......Distance to nearest lot line_.._.t \. Number of lines--------- -------r _/..-----.---- ength of each line--_.-----G. .'...____...Width of trench.-- $!e..:___--_-....-... ..- i Type of filter materiaL_f.tXV epth of filter material----z��f-- - Total length....--- ------------------ Seepage Pit:. Distance to nearest well----------------------Distance from founda#ion___.._r.............Distance to nearest lot line................. % ❑ Number of pits----------------------Lining material--------------------...Size: Diameter.......................Depth------...-_.__.__._.-- Cesspool: Distance from nearest.well_________________Distance from foundation--------------------Lining material-------------------------- . 0 Size: Diameter_-- ---- ----- ------ ----Depth---•------------------------------------------------Liquid Capacity---------------------------- gals. Privy: Distance from nearest well---------------------------------- ------ -_.____Distance from nearest building-_-----_--.---------___._____...___..._._. ❑ Distance to nearest lot line --•--------••-------- - ---- v Remodeling and/or repairing -----.-----_; '`_ ---- -.-- .- '-----------------------------------•------.- 1p -----------------------•-------•------------•-------•------•------•----•--•-----••-•--•--•-.----------•----._....-.•-.-.----•---•-•-•-•-----•-----------._...-------------•.------------------------- ---- ----- --------------------------------------•------------••••-------------------------•••---•-----------------------•----•----•---•-•-----•-•-------------.------------------------•----------------------------------------------- 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 reg lations of the San Joaquin Local Health District. (Signed) - --------( or Contractor) Title (Plot plan, showing size of lot, location of syste relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ----------------------- ------------------------------- DATE------------------------------------------ REVIEWEDBY--------------------_-- -----•-- ------- ------------------------------------------------------------------•.------.----- DATE----------------------------------------- BUILDING PERMIT ISSUED............. ---------------------------- .............. DATE---------------------------- ......... -------•----- Alterationsand/or recommendations:-•------------ ---------•------------------------•-•-•-----------------------------------•-----•--•-------•------------••- •----------------••--- ------ ---------------------------------- -- - • . ......------•---•--------- ----------------------------------------------------------...............-.-..------- ------------ .------------•---------•------- •------------------------------------------- ---- . -•----•-- ------- --------------- - ----- ------ --- ---- I FINAL INSPECTIC N—B-Y.. . .....V1-141:1 .. .... ... .... .. Date........a.._ -_. ..� . .....-.. ... --...-------•-•-.._....... SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore .StreGf 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California I FS-9-211d Revised 8.'59 F.f.Co. J T