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FOR OFFICE USE: --------------------- - -- ........................ .................................................... .... APPLICATION FOR SANITATION PERMIT Permit No. ....... ............... ----- . ...-•--•---.................................... (Complete in Duplicate) .......................................00.00._. i 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. 2-3dVC .R/• JOB ADDRESS AND OCATION OQ�! ----- . _0.000..-0000._x?'`_.. rte_ ...... ...... ..... ---- �t Owner's Name.......... . ......... . _... . Phone..................................•. Address--•- l ....--• -.7r's _ ...... .. ...... --------------• ---•--•-•--•------_-- ---•---- 0000- --------------------- - 0000_... Contractor's Name._..... �..�..__. .. •----•----•-•---------••---•--------------------------------•---- Phone------•........................... Installation will serve: Residence 2" Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _1..__ Number of bedrooms _5.__ Number of baths y__ Lot size ---------------------______________ Water Supply: Public system ❑ Community system ❑ Private 'e Depth to Water Table _..___ 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 ❑ 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 Tank: Distance from nearest well...471.�_Distan from foundation___f.©_'__.-_._.Material_._..e�/bt.�l ........................... No. of compartments..........;..-'-...........Size .__Liquid depth........ .........Capacity..l;,.tauf.._ Disposal Field: Distance from nearest well_._4P4Distance from foundation._..1Q.........Distance to nearest lot line-51"._._.. _....Length of each line A!"—. S �a?YWidth oftrench.._=-�........................ rC, a]/ Number of lines________________�........._ Type of filter material-_ -mV...�......Depth of filter material..._J_.1_"......_..Total length_-_. !C?A:..........._----------- 014 Seep 'Pit: Distance to nearest well......L.VPI-.___Distance fr m foundation..../..P.r.._.Distance to nearest lot Number of pits........ Lining material.. ---------Size: Diameter._....3.J.`.........Depth.... .................. Cesspool: Distance from nearest well.................Distance from foundation------ Lining material..__ ...........0.......0.0.0_.-___. �? ❑ Size: Diameter......................................Depth................................. ------------------Liquid Capacity----------.................gal'. 7 Privy: Distance from nearest well..................................................Distance from nearest building.................----------.............. ❑ Distance to nearest lot line................................................------•--•--•-----------•-••----------•------------;----------------•---..-------•-------- Remodeling and/or repairing (describe):..........------ -------•-•--------------•---••-----------•-------------•-------•---• ...._0000._.:...................................0000. ..............................•-•-••••-••.........................•-.....------...-•••--..........••••.._-.._..•••••••--.I......._...-...................,.......---._. ..............................•...................... ...........•.............•---------•--•-----•-•--.........--....--•---.....------•------•-••---.......................•..............................................................•--------- -•-------.._..-•-- ••------...._ ................. ............................................-...............-..................__................................... ...-.........--.--•-----...........---- ------------- I ----- 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 regulations of the San Joaquin Local Health District.' t---�w%,-- (Signed)--•.............................. .. ............ :00.00.. .......AOwner and/or Contractor) By:--------------•------------ {Title) "`- (Plot plan, showing size of lot, location of system in relatio to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.. . DATE. - - - .. ._ ...................................0000--•--0000._. ..._......-•- --------------------------------- •-- REVIEWEDBY..................................••---------.-•---_----•---_-•--------------------------------------------------------- DATE..............................----•----•-•--------- ----- BUILDINGPERMIT ISSUED............................-.................................-........•............................. DATE-------------------------------------------------------.----- Alterationsand/or recommendations:..............................................................................----•--•---•----------------------•-•--•--------------------•-------------•------ -------•-•...................................................................................................................................................--..__..._.....-...........................0...0............... ...................................................................................-••.............................................................................................................-..................... - ..................................... � - / FINAL INSPECTION BY ._._.. -...._.. Date.e7 ,....2.:-. ..G-.I'.... `r, '- �'r',,�,t' SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haeelton Ave. 300 West Oak Street 144 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,calffornia Tracy,California ES 9 REVISED 8-59 3M 3-'63 F.P.ED.