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FOROFFICE USE: Ii ------------------- ---------- ------------------------ II. APPLICATION FOR SANITATION PERMIT Permit No. ----------------------- -------------------------------- -- ----- ------------------------ -- ----- (Complete in Duplicate) • 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 ap kcation is made in compli ce w1 _Iith County Ordinance No. 549. ', } JOB ADDRESS AN LOO � � °�' '" Mr- "` � ----•---------- ------------- Owner-'s Name - - ------------- Phone---------.---- f�,� - 7 ------------ - Address ` = C ------- --------E--------- - ------ ------ - Contractor's Name . y Phone t Installation will serve: Residence ❑ Apartment House ❑ Commercial [M"'Trailer Court ❑ Motel ❑ Other Number of living units: .'-___ Number of bedrooms Number of-baths __ `Lot size ------------------------------------------------------------ �k Water Supply: Public system E] Community system El Private Depth to Water Table -------- ft. �'I f Character of soil to a depth ofk3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ l Previous Application Made: (Ifl yes,date----------- No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: r (No septic tank or cesspool permitted if public sewer,is available within 200 feet.) Septic Tank: Distance from nearest well..........:......Distance from foundation--------.-----_--,Material---_____--_-_-_---__----___-.-.--- _--..-.-. ❑ No. of compartments--- ------ -- ----------Size---------------------------- q p. ------- Capacity----------------------- �I _ Liquid de th._�'...____.__. . _ Dispos geld: Distance from nearest well__.rp�_-__-Distance from foundation----.�_r'�__-_---..Distance to nearest lot line__.-__---_- Number ofIiines-------------�..._--- -----------Length of each line-------- ..Width of trench_____--7.11-,_.------_--------..- Type of filter material-_-_-__��_.�___.----Depth of filter material--_.-_3_').�r____.Total length----.-00_�--------------__----_---. ;r Seepage Pit: Distance foe nearest well----------------------Distance from foundation----_-_------_--___.Distance to nearest lot line--.---._--.__--_ ❑ Number ofjpits----------------------Lining material---------.-------------Size: Diameter-----------------.--- Depth--------------------------------- Cesspool: Distance from nearest well--- Distance from foundation v._'.________.Lining material-_.____----__..______-.-___-----_. ElSize: Diameter------ -------------------------------Depth----------------------------------------------------Liquid Capacity_. Ill Privy: Distance from nearest well---------------------------------------------------Disfance from nearest building._-.--..----_-.-----_--------.---.-._----- El Distance to nearest lot line- -------------------- ------------------------------••-------------------------------------- --• -------------------- il Remodeling and/or repairing (descr;be)------ ------------------------ ----------- � ------------------------ --------------------------•------------------------:---------•----------------•---- --- - ------r ' ----------------------------------------------- il ----------------------------------------------------------------------------- -------- ---------------•--------------------------------------------------------------------------------------------------------------- - ---------I Hereby certify that I havl-----------------------------------------•---------------------------------------------------------------------------------------- ------------------------------- ------ e prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State I s, and rules and regulations of the San Joaquin Local Health District. I ----. and/or Contractor {Signed) - ---- - / � "� Title {Plot plan, showing size of lot, location of sys em in rel ion to wells, buildings, etc., can be placed on reverse side). ,I. FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED Bl'_. ; ------------------------------------- DATE---- lea REVIEWEDBY- ------------ --------- ----- ------------ ----------------------------------•------•---- DATE---------------------------- BUILDING PERMIT ISSUED-----!I------------------------------------------------------------- -------- -------------------------- DA-Te------------------------------------------------------------- Alterations and/or recommendations- ----- --------------------------------------=----------------------------------------------- ------ --------------------------------------------------- ---------------------------------------------------------- - ---------------- ----- -------------------------------------------- ----------------------------- ------------------- ------------------------- --------------------------------------------------1 ------------------------ I ------------------------------------------- ..... ------------------ - -- I FINAL INSPECTION BY:-_ �� r ------------- Date_41.0_4/)------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Ma:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California .� Lodi,California Manteca,California Tracy,California k F.P.CC. -. } 1