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FOR OFFICE USE: ----------------------------------------------------- --- i w. --------------------------------------------------------- APPLICATiON FOR, SANITATION PERMIT Permit No. ------------------------------------------------ (Complete ins Duplicate) Awl 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. p5` 07 e2 l.3 e qCep E. C--,` ,�14 JOB ADDRESS AND LOCA7 ,f` ---- --------- � " -44 ----- ,t4 Owner's Name..------ - r/ !� ---------- - Phone Address .!. ! ! > 4 Contractor's Name-- ----•-----------•----------------------------------------------- ----------------------------------------------- Phone..-•----•-------------- Installation will serve: Residence [� Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ ' Number of living units: -l..... Number of bedrooms .. Number of baths J'_�L of size _1�4.�_fq_S------------------------------- Water Supply: Public system ❑ Community system ❑ Private I1 Depth to Water Table ;$k_ 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 E]-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-----------------Distance from foundation--------------------Materiaf.---------------------------------- ---_-- ❑ No. of compartments--- ------ ---- -- -Size--------------------------------Liquid depth--------- ------ -------- Capacity---------------------- Disposal Field: Distance from nearest wells. ........Distance from foundation--/----.---------Distance to nearest lot Number of lines-__- .-. . -. ength of each line--._ r O Width of trench..-- . t of filter mater Depth of filter material... . .-.`!........Total length. �j-y�.. --------------------------- Type Seepage Pit: Distance to nearest well......................Distance from foundation--------------------Distance to nearest lot line-------_--------- 4�1 ❑ Number of pits---------- ------- ---Lining material-----. ----------------Size: Diameter----------------------Depth-----------.--------------------- Cesspool: Distance from nearest well_..----....._..Distance from foundation------------.......Lining material----------------- . Size: Diameter-------------------- ----------------Depth--------------- --;------------------------ --------Liquid Capacity- -------------------------gals. Privy: Distance from nearest well-----------------------------------.--------------Distance from nearest building ------- --------------------------- F-1 Distance to nearest lot line - - - ------- ------------------- - ------- ------------------------------------------------- f . --------------------------------------------- ---- -------------------------------------------- __- . --------------- Remodeling and/or repairing describe :---_ ` - ----�fi' ...____-- -- ----- - -- -- - - - -- -- - - ------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------ 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 - -_ -r-- ---- -- _== ------------ -_- 4-=-----------r (Owner and/or•Contractor) Y • ------•-- ----- _ _- -- ==r-------------------------I-------------------(Title (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). V FOR _DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_ ��-a � _ ------ ------------------ --- DATE-_ _ f U -- -------------------------- REVIEWED BY------------- � ------------------------------ -- 7'--------------------------- DATE----- ._;L`—�•- -` - ----------------------- BUILDING PERMIT ISSUED--------------------------------------------------------- ------------------------------------------ DATE--------------------------------- --------------------------- Alterations and/or recommendations-------------------------- --------------------------------------------------------------------------------------------------•----------------------------- --------------------------------------------------------------------- --•----- ---- ----- -------------------------------------------------------------- ---•------------------------------------- ------------------ ----------------- - ---------------------------- FINAL INSPECTION BY: Date ..- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street —• 724 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.