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OFFICE USE: S APPLICATION FOR .SANITATION PERMIT ? . ----- Permit No. ---_-- �s'� ------------------------ ---- - ----------- ------- _ (Complete in Duplicate) DT ate 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 herein described. This application is made in compliance with County Ordinance No. 549. �� JOB ADD ��A��))D LOCATION -------------------------------- Owner's Name__(Ol� R 9 Phone._.. i -- - - -- - - - ---------------------------------------------------- - ---------- Address ---------- -&------.---------------;---- ---- - -;t, Contractor's Name__-__- ' . Phone.............. -----------=----- ------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ `Ottthher ❑ oe Number of living units: __.Number of bedrooms _ Number of baths __�L____ Lot size ---..---_____..__._ Water Supply: Public system Community system ❑ Private ❑ Depth to Water'Table —0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9-"O'Hardpan ❑ S Previous Application Made: [If yes,date.--,------:.........l 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 jank: Distance from nearest well----'°��__"__Distance from foundation--------------------Material--------------------------------- .._..__..._._._. at f 10 f No. of compartments----- -----=-----Size--------------------------------Liquid dep`h--------------------------Capacity------------- --------- Disposal Field: Distance from nearest well_ from foundation__1.3a-______-Distance to nearest lot line_4li- —_____ l Number of lines_____1________�.._- -_..__ ength of each line____� � Width of trench-.Z/---------- r of filter material_. _ _ ___ epth,of filter material___:,------------Total length___ : �__________________________ Seepage Pit: Distance to nearest well ^�"_"___ Distance from foundation_ _ � ____ __��__.Distance to nearest lot line_ �_--.-. [}� Number of pits._.__/-------------Lining materiaL_�!_44..Size: Diameter_S �`__...___Depth ----___________________ �• Cesspool: Distancle from nearest wel€------------------Distance from foundation--------------------Lining mat erial-------------------------------------- J ❑ Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity------------------------#.-gals. Privy: Distance from nearest:well_----------------------------------------------Distance .from nearest building--------------.___._".__----------"....... z ❑ Distance to nearest lot line---------------Y ----- --------------------------------------------------------------------------•-------- --------- Remodeling and/or repairi9 (describe :- rte ------------------------------"--- ----------•------------=-------•----------------------------------•----------------- - ,----- ------------------ ----------------- --------1---------=----------------------- :-----------------------------------------:---------------------------•---------------------- ------------ -- - .. I hereby certify that I have prepared +his application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and re ulations of the San Joaquin Local Health District. fi Si nedAW - - r Contractor I� (rile) BY•----------•------------- r _.... (Plot plan. showing size of lot, location of-Sys, in relation to wells, buildings, etc., can be placed on reverse side). I� FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------- --- ---------------------------- DATE------ �/ REVIEWED BY_ -------------•'1-------- -- - - ------------------------------ ----- DATE BUILDING PERMIT ISSUED------------------------------------- ---- _ ----- PATE----------------------------- --------- -- - ------------------------------- Alterations and/or recornr4ndations:_____'-�:_r E �' - --- - FZ�cs -- r _ FINAL INSPECTION BYE:--------------------------- ---------- Date---- - -------`.!.---- =---- --------- - ------------------- ------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Avoll 300 West Oak Street y 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 4 RNv1SEd 8-S9 3M 3-'631F.P.Cd. t� II 1