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FOR OFFICE USE: _ APPLICATION FOR SANITATION PERMIT Permit No. .' ---- -------- --------- ------------------------------ (Complete in Duplicate) ;. t --- --------•---------------------------------------- t Expires 1 Year From Date Issued AW Date Issued This Permit . Application is hereby made to the San Joaquin Local Health District for a permit to cons uct and install the work herein described. This application is made in compliance with County Ordinance No. 549. 00 - 2_&0 -rlr' dSaJOB ADDRESSAND CATION ------------------------ Owner's Name----- •------------------------------- -- - - ---- ----------- ------ Phone--------------------------- ----•--- � - G %Address---------- o --------- --------- Phone...-Contractor's Name .-- --- - Installation will serve: Residence Apartment 1=`louse ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ L � „ � r Number of living units: _-_/ m _`Number of bedroos _3__ Number o baths �Lot.size ,�� -- ----------------------------------- ~ Water Supply: Public°system El Community system [I Private 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 ❑ Q TYPE OF INSTALLATION AND SPECIFICATIONS: I (No septic tank or cesspool permitted if public sewer is available within 200 feet.) _44 Septic ank: : Distance from nearest well____50_- Distance from foundation---_/4_..-_.__.Mat'errial.__�}G�_____________ No. of compartments_....._ .--___-__---Size-- - -- - -.X,S --Liquid depth-------,-T-------------Capacify_.�a��-- -• i Dispos field: Distance from nearest well _. .P...r___Distance from foundation-__/P. Distance to nearest lot Gne ___-__ ...... e Number of lines----------------------------- ---Length of each line--------f _e--------------W __--- idth of trench ------- ------ f t Type of filter material------ S,-R --'_---Depth of filter material-----/__9-��--- - ---Total length .- - -------------------------•- Seepa e Pit: r I Distance to nearest well----/.�!o_.I-_-____Distance from foundation____!: -_ ---_-.Distance to nearest lot line___6-_--__--_- . INumber of pits.---------.---------Lining material-------$.i .......Size- Diameter.----- Depth_..,A.5-----:--------------- Cesspool: Distance from nearest well________________ Distance from foundation-------------------- Lining material------------------------------------- F1 ,._..____-.---____.__-_.--_-__._.._.❑ Size: Diameter----- ------------------------- --- Depth---------------I------------- -------- -------------Liquid CapacitY ---------------------------gals. I Privy: Distance fromnearest well------------------------------------------------ -Distance from nearesf building--------------.-------------------------- I ❑ Distance to nearest lot line__ ____________ -------------------------- Remodeling and/or repairing (describe)------------- --- -- ------------- --- ---------------------------------------------------------•---------- ------------•-------------------------------- - �_ . .. 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. (Signed).. = - --- By: ------------ ----------------------- ------------------------------------ rand/or Contrac I ..-------------- for ---� -- --- (Title)--'-------- . BY=----------:------------- -- -' ---- --------------- - --------- (Plot plan, showing size of lot, location of system in rela on to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY-- ------- -- --- L -------------- -- ---------------------------------------- DATE-6r '' -------------------------- REVIEWED BY------------------------------------------------------------------- ----------------- -------------------- ---- DATE------- ----------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------------------------------------- Alterationsand/or recommendations:-------------------- - -----------•---------------------------------•------------------------------------------•------------------ --------•---------------•--- -----------------._------•------------------------ FINAL INSPECTION ------------ -•- ------------------------------------ ----- 1 SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.0 Q.