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FOR OFFICE USE: s --------------- -- ---- --------- - -------------- ---- -------------"----.-- --------------------- -------- APPLICATION FOR SANITATION PERMIT Permit No. _ - �- ---- ------------------------------------------------------------------------------------------------ (Complete in Duplicafel � 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 herein described. This application is made in compliance with County Ordinance No. 549. l0$ ADDRESS AND O4CT f-Owner's Name--------�i� * - ----------------- �---------------- - - - Phone Address--------1 �- �'----------------- Contractor's - ----- - ---- -Contractor's Name -- --------------------- Phone----------------------------------- Installation -------------- •---------- -- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/.- Number of bedrooms - - Number of baths S---- Lot size - - Water Supply: Public system ❑ Communitysystem y stem ❑ Private PDepth to Water Table " -- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe g3o�'Hardpan ❑ Previous Applicafion Made: (If yes,date---------- ---------) No 9 New Construction: Yes Rk"No ❑ FHA/VA: Yes ' No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 240 feet.) Septic Tank: Distance from nearest well.f��.--Distance from foundation" -_-.------- Materi J__e d x ` ---------------------- L No. of compartments Size> 'ss _xaij' uid depthf Capacity "--p- Disposal Field: Distance from nearest well----- --Distance from foundation___-,/�--i-----Distance to nearest lot �_----- y `-- - --- Length of each line. ,'0'*A -1V-_AOWidth of trench--.-_-------------------------------- Type --------------------- } Number of lines-------- _----.. " T e of filter materiall/� p Yp -- - ��--Depth of filter material-- -.-d9i'__-----dotal length_,,?4Q--------------------------- Seepage -------------------- ---- Seepage Pit: Distance to nearest well---------------_-----Distance from foundation-------------------.Distance to nearest lot line_.--.-____--...- (� ❑ Nlumber of pits---------------------Lining material---------------"--------Size. Diameter-----------------------Depth-------------------------------__ Cesspool: Distance from nearest well---_------------Distance from foundation.--.--_.-_--_.__--.Lining material--_ i� ❑ Size: D is mefer--- -f---------------------------------De th---- / .....�.� 4-..z. _ —_ - . ' -- ------ - �, Liquid CapacitY,---------------------------gals Privy: Distance from nearest well--------------------------------------------------Distance from nearest buildin ❑ Distance to nearest lot line - Remodeling and/or repairing (describe):-- ------------------ -------- ----------------------------------------- ----------------------------------------------------------------------------------------------------------------------------------------`--------------------------------------------------------------- _ __ .. I hereby certify that I have prepared +his _-- application and that the work will be done in accordance with San Joaquin County. 1 l ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)_- ------------------------------ ------ s/ ------ ---- -- ----- ----- -�--- ---------- --- ---- Contractor By:------------------------------------------------------------------------------ ) -- ---- -- --------- -------(Title)-- t �--- ------------- ---- -- ...... (Plot plan, showing size of lot, location of system in re on to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ) APPLICATION ACCEPTED BY------------ ------------- ---------------------------------------------------------- DATE. - r REVIEWEDBY------------------------ ---------------------------------------------------------------------------------------------- DATE----- --------------------- PERMIT ISSUED------------------------------------ ------------------- ---------------------------------------------- DATE. ------------------------------- Alterations and/or recommendations----------- --------------------------_"---..-_ - .-. ---------------------------------------------------------------- -- --------------------------------------------------------------- P --------------------------- r t FINAL INSPECTION BY------------ --- ----- - -------------��f" � "W - -- Date------------- ------ ----- - ------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.kaselton Ave. 300 West Oak street 124 Sycamore Street 205 West 9th Street Stockton,California La4l,California Manteca,California Tracy,California F.R.0 o.