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t 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 hereinescrbed. This application is made in compliance with County Ordinance No. 549. �4t JOB ADDRESS`AN LO TlON------...��-- -...... ... ................... ------IC4,...................... . . ..... - -- ----- Owner's Name. _ p. -••---•......-• Phone------------------------ /�r -------.... . -- Address.----•42..•[.-.....--J - � --•--• -- .......... .................................................. Contractor's Name--------------- - -- •.------`. • -•-•--•-• ..... .......-•---••-•--•---•------•--••-••-•-•••---•-------...._....----...... Phone. -------•-- Installation will serve: Residence ❑ Apartment House ❑ Commercial Trailer Court ❑ Mote L] ther1. Q Number of living units: r. Number of bedrooms .~. Number of baths _.:----- Lot size ?- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table'.7 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel 0 Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date.__.' ............ No Z_ New Construction: Yes No ❑ FHA/VA: Yes ❑ NA� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted-if public sewer is available within 200 feet.) �••• Septic T Distance from nearest well_________________Distance from foundation....................Material.................................................. No. of compartments............. ------------Size................................Liquid depth..........................Capacity....................... Disposak Fie Distance from nearest well.,57�.......Distance from foundation..7..............Distance to nearest lot Ip,e.... __._.. Number of lines..../*............. Length of each line_J'0_._._..,,y__._...Width of trench.-a-.-j.L_.................... . Type of filter material. --Depth of filter material---1 .... -....Total length___._�Q............................i 0 Seepage Pit: Distance to nearest well..kq.`f .......Distance from ou d i n_-a.0_....__..Di a �� to nearest I t 'ne..... ._..l Number of pits------/....__..=--:Lining material_.. :ameter.....� __.___ _Depth.... . .....................i Cesspool: Distance from nearest well.................Distance fromtunclation..P ------------------Lining material---•---••-•----•----•---••--------.._ -� ❑ Size: Diameter. •--••......................Depth-------: .._........---•-----------...--•-- ----•-Liquid Capacity----- ....-•-- --- .gals. i Privy: Distance from nearest,well.................................................Distance from nearest building........................................... , ❑ Distance to nearest lot line .................•--•.--•--•......---------------•-•----•-....--------•••-----.............._....---------------••-------•----•-- Remodelingand/or repairing (describe):..............•-------••------•--.......------------•--.......----------------------•--•-•------•------•------•----------•--------•---------•--•-•------• ..........--.............................................................................................................................................-----------•--••-•-------•-•-•-•-------•-------.....-----•--•-.--••- ' - In .......... -----•------•-•----•-•-------•------....------................................................................................................................................. ----••-•--•-------------------------- ---•--•--•------••:••-----------------------••-------------•--•-----•••------•------------•------------•---•--••---....------. •-•--••--•---------••-•-------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State Jaws, and rules and regulations of the San Joaquin Local Health District. (Signed -f- ........... ...... •-------------------••--......------ ------.•--•------------••-------•............•...--•-•---------• (Owner and/or Contractor )....... By:._...••------•-----------•••--••----•---.....•---••----•---•-•---•••-----•••---••-••--------••-------------------•-•-•-••-•----•-••.(Title)---------------------------------------------------------------- (Piot 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..............................................••----------•--------• -• ---..........-----... DATE---------•---•-•------------------------------------------- REVIEWEDBY------•------------------••---............._...--------.....-----------•-•---••-- •• DATE--•----• -- BUILDING PERMIT ISSUED.............. ?' � ---- DATE----•••- -----------------•---- - Alterations and/or recommendations------- -------.....--......----•-----------------•-.........----.-....----....---•-••----------..............-----------...............•......_....----•------ .................................................-•--..._•------••---•••--•------•----...------•-------•----•------•-.......---••---•--.---••-••------•---•-----......------................................................ ..................................................•--•--••-•--......---•--------------........-••---.........-----............-•-----•---••-----•--•--•---••---------•-•-•••----•---•-••--.._....------------------••- .........................•-••---- ................................ ---------------•.......................... .............................-..................................................................... ..................... . -----...--•-•................•. ......_..... _...... . -------•-------...---.....------•-••---•-•-- ---------------------------------------------........ •. I FINAL INSPECTION BY:................:.......•--• . . ..... .... '. Data_------f --a5-�3 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Strut 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVIBEO B-59 3M 3=63 F.P.Ca.