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FOR OrFICE USE; - --- -----------------_.____--..------ - ------------ APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------------ ----------------- [Complete in Duplicate] 7/•--- -- --- -- --------------------------------- This Permit Expires 1 Year From Date IssuedDate Issued _._____ __,klY HApplication is hereby made to the San Joaquin Local Heal}h District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. /g 17 D--© 4 JOB ADDRESS D LOC TION ---------- -- -• ------------ ------ -----� }. Owner's Name-- a -------------- ---------------- Phone_3.Z7--- Address Address..�_�.ia_-�_-- ___-- - . Contractor's Name ---------- - ----------------- Phone.. Installation will serve: ResidenceApartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:y_._ _ Number of bedrooms - __ Number of bafhs`�'�_____ Lot size _,�4 S_�._ c _�----------------- Water Supply: Public system! Community system [❑ Private ❑ Depth to Water Table 40_ ft. Character of soil to a depth df 3 feet'., Sand X. Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 0 Hardpan El )Previous Application Made: (If yes,date------------------:) No ❑w -New Construction: Yes ' No ❑ FHA/VA: Yes ❑ No ❑ !TYPE OF INSTALLATION AND SPECIFICATIONS: ' nk or ool 'Septic Tank: }aDistancesfpom npermitted ea estf deif ubli [Distance fromavailable founda oo 4_.-_____.Materiall% ' 1 No. of com artme _ Size_ �-z_,_/S q d dep�h--._��.---___----_.Capacity_¢��D P ------- _�--- �` � .Li ui Disposal Field:— Distance from neares�,e, . _ _04& Distance from foundatign A:).JR- -.Distance to nearest lot line--i-_-----Jr v� Number,of lines_---- _ Length of each line -' 0- Widtn of french-ry_________________ : 'C- z Type.of filter`ma erial-5__ -_Depth of filter material---ZcU ------ length---.____- Seepage Pit: Distance to nearest well`t,--------------------Distance,f.rom.foundation------------....-.-.Distance to nearest lot line------------ ❑ Number of pits---------- ------Lining material------------------------Size: Diameter------------------------Depth------------------.------------ Cesspool: Distance from nearest well----------t-----Distance from foundation--------------------Lining material--_-...___--._______---.-__---..-__. . ❑ Size: Diameter------------------------- -----i-----.Depth------------------`--------------------------------Liquid Capacity- ----------------------.---gals. 'Privy: Distance from nearest well.---------- ------------Distance from nearest building-----...--------___---_--.-.____-__._--. ❑ Distance to nearest lot lin ------------------ - --------------------------------•---•------------------------------------------------------------------------ ' Remodeling and/or repairing Idescribe)----------------------------------- -----------------•--F-------------------------------------- ------------------------------••------------•--------- ---------------------------------------------------------------- ---------•----------------•-----------------------------------.---•---------------------------------------------------------------------------------------- -----------------------------------------------------------------------------------------------------------------•---------------------------------------•-------------------------------------------------------------- I here ce y that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinanc ate ws, and rules and regulations oft San Joaquin Local Health District. (Signed)-. ------ -- -- -------- By: ---- ----- -------------------------------------------------------------[Owner and/or Contractor] i B •------------------------------- ----- Title :(Plot plan, showing size of toP:t_!4 caion of system in r tion to wells, buildings, etc., can be placed on reverse side). – FOR DEPARTMENT USE ONLY .APPLICATION ACCEPTED BY------ ----t ----------------------------- DATE -------- - - -------------- REVIEWEDBY----- -------------------------------------- -----------------------------------------------------(-----------------------. DATE--------------------------------------- ::BUILDING PERMIT ISSUED-------------------------------------------------------------- ------------------------ DATE------------------------------------------------------------- `Alterations and/or recommendations: --------------------------------------------------------•------ ------------------------------------------------•---------------------------------------------------------------- -----------------------------------------•------•------------------- - ----------- ----------------- ----------- ---------------------------------------------•--------------•---------------------------------------------•--------------------•--- ----------------------------------- FINAL INSPECTION :. - Date----------- ' -rt--- ' SAN JOAQUIN LOCAL HEALTH DISTRICT y .1601 E.Hazelton Ave. X300 West Oak Street ` 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California f Tracy,California ES 4 REVISi=C �-59 3M 3-'63 F.P.CC.