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FOR OFFICE USE: / ,f ys _-- APPLICATION FOR SANITATION PERMIT Permit No. - ----------------- -.------- (Complete in Duplicate) 7 This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health bistrict for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS ANDOCATION-__�_ . Owner's.Name--- e Phones Address-------------------- -----------------•----------------------------------------------------------------------------- -------------------------------------------- Contractor's Name.---- •---=---- -----------------_-------------------------- ---------------------------------- Phone Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units.- _-..f-_ Number of bedrooms_-3. Number of baths -- Lot size _--- /�_��L- ---------------------•-------- Water Supply: Public system [,_Community system ❑ 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 2- New Construction: Yes ❑ No [?f�FHA/VA: Yes ❑ No 91- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer-is available within 200 feet.) Sep ank Distance from nearest well------------------Distance from foundation------------.-------Material------------------------------------.-----------. 'I No. of compartments- - --- ----------- ------Size---•----------------------------Liquid depth--------- ----------------Capacity----------------- ---- Disposal Field: Distance from nearest well. ----Distance from foundation-..l0-f---.---.Distance to nearest lo{ line-- `------.-- Number of lines- --_a��- -----------------Length of each line-:-�R_6.- ----.-Width of trench---�.-- -_ - Type of filter material__J.�aGI�--------Depth of filter material-/&--`- --------Total length----AS-0-- ----------------------- Seepage Pit: Distance to nearest well---- --------------Distance from foundation----/0..........Distance to nearest lot line----%j-------- -- Number of pits----�-----------Lining material---�aC�f'--Size: Diameter..---�3_........Dept h--------.-- Cesspool: Distance from nearest well-----------------Distance from foundation-------------------.Lining material-------------------- ----------. ❑ Size: Diameter. s--------------------- -----------Depth.-------------------------------------------------- Liquid Capacity- --------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building.----------------______----_----.--------- ❑ Distance to nearest lot line----------------------------- ---------------------------------------------- -- ------------ ------------ ------------- ' V1 Remodeling and/or repairing (describe)----------- ------------------------ ---------------------------------------------------------•---------------- ------ f0 ---------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ________ -------------------------------------------------------------------------- ------- - - ---- - -- ----- ----- - I hereby certify that I have prepared this application and that the work will'be done in accordance with San Joaquin County ordinances, S✓tatq laws, and rul s and regulations of the San Joaquin Local Health District. p( i - ' ---(Owner and/or Contractor) -------------------------------------------------------------- ---------------------------------------------------------------------(Title)---------- --------------- -------------- - - ---- (Plot,plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY - ' DATE------ ----- ' REVIEWEDBY------------------------ ---------1-------- --------- ---- ------------------------ -------------- ------------------------- DATE-------------------------------------------------------- --- BUILDINGPERMIT ISSUED-----•--------- --------------------------------- -----------------------------------I----------------- DATE--------------------------------------------------------- --- Alterations and/or recommend tions--------------------__---..---.---------- r_ _ i / �f r --:--=--- ---------------------- - ------------- ----------------------------------------------------- ------------------------------------- ----------I- - ------------------------- -- ---------------- ---------------------------- ------------------- --------------------------------------- 1 -------------------- -------- Date.--- /I -f •�- FINAL INSPECTION BY: -- SAN JOAQUIN LOCAL HEALTH DISTRICT r 1641 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California