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FOR OFFICE USE: - ----------------------------------------- -------------- ---- __`3APPLICATION FOR SANITATION PERMIT Permit No. ..f�.�l ----------------------- --- ---------------------------- (Complete in Duplicate) 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 oak hereindescn d. This application is made in compliance with County Ordinanc No. 549. / JOB ADDRESS A LOCATIO ----> _ __ _ _ l___ --- . ---------- -- Owner's Name-------- - -------------- Phone------------------------------------ _..AdAddress------------------------------ dress----------------•------------- ---- ---------�--�--- Q1�---- - -----•--------- --------------------------------------------------------•------- Contractor's Name-------- - ------------- ------- --------------------------------------------------------------- Phone------------------------ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-4_- Number of bedrooms _a-_ Number of baths -./_- Lot size ---------- ----------------- Water Supply: Public system E] Community system El 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____________________J No 25•- New Construction: Yes ❑ No 24-FHA/VA: Yes ❑ No Z;.- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SeLtic Task:,, Distance from nearest well-----------------Distance from foundation--------------------Material------------------------------------------------ - �i e o. ocompartments�1�� Nf pLiquid deP.th ------- - Capacity---------------------- r i �j - Disposal Field: Distance from nearest well.....f� ---Distance from foundation__-- ��____.__.Distance to nearest lob line---—--------- Number of lines ------- __ Length of each line___.,.'f`0_f____ __ Width of french..ae�r_.__.._...-- (y Type of filter material-j ' Depth of filter material---- Ae�l-.. .Total length.-. `�. ______.______________ Aga Seepage Pit: Distance to nearest well---------------------'Distance from foundation------------.------ Distance to nearest lot line----------------- El Number.of pits----------------------Lining mate r•sal-------------:--------Size: Diameter-.---------------------Depth------------------------------ Cesspool: - •Distance-from'nearest well------- _____--_.Distance;-f.romfoundation_________________..Lining material__.______._____.__.__.._________.__ ❑ Size: Diameter__ t. F=------------------- - ---Depth----------------------------------------------------Liquid Capacity----------------------------gals. ____________________Distance from nearest buildin ___._-. i Privy: Distance from nearest well----------------------------- g.----.---.--------.------ ---...__. ❑ Distance to nearest lot line.. --------- - -- ----- ------------------------------------------------------------- ---- -- - Remodeling and/or repairing (describe)----------------- .•.,1 t --------- ---------------------------- -------------------- n ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ----------------'------------------------------------------------------------------------------------------------------ ---t--------------------------------------------------------------------------------- ------.------- -----------------------------------------------------------------------------------------------------------•----------------------------------------------------------------------------------------------------------- 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. (5t ned 9 )----------------------- -- -- --- --- --- -------- { nr Contractor) # By:-------------------------------------------------------------------------------- -`r-----------(Title)---4*_ ------------------- (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_ .. Sr._ DATE- - ---------------- ---- -REVIEWED BY---------------------------------------------------------- ---------- DATE--------------- l./ BUILDINGPERMIT ISSUED----------------------------------- ----------------------------------------------------------------- DATE------------------------------ -------- ------------•------- "''';Alterations and/or recommendations:.---------- ---------------------------------•-----------------------------------•--------------------------------------------------------------- - --------------------------------------------------- --------------------------------------------------------------------------------------- -- ----------------------------------------------------------------------------- t ---------------------------------- - ----------------------------------------------------------------------------- --------------- -------------------------------------------------------------- -------------------------- ------------------------------------------------ -- - --- -- --------- --- ------ ---------------- -------------------------------- -------------------------------------------- -_ o - -------------------------------- FINAL INSPECTION BY....t ----------- -------------- Date_ ,? j/--f&--- ------------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT, 1401 E.Kaxelton Ave. 300 West Oak Street } 124 Sycamore Street 205 West 9th Street a Stockton,California Lodi,California Manteca,California Tracy,California F.P.CC.