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FOR OFFICE USE: ---- APPLICATION FOR SANITATION PERMIT Permit No. . .f�•�--� (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 work herein described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN ------------------------------ -------------- - ------------------- ---- Phone_ Owner's Name---- .- ----- -------- - - Address ------- ----•------------------- --------- ------------------------------------------------------------------ Z ---Z �G---- r� -- -----------------•---- ----------•---- Phone-----__-----------------•---------- Contractor s Name__-�--- ^�'"`-- - -- - - Installation will serve: Residence [91 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-I-_- Number of bedrooms ----- Number of baths :?:��Lot size __._, _ --+------------------------------ Water Supply: Public system ❑ Community system ❑ Private [+Depth to Wafer Table -------- ft. pan Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Ad beE]s Hard No El Application Made: {1f yes,date--------------------1 No F1 New Construction: Yes ❑ No [I FHA/ E] TYPE OF INSTALLATION AND SPECIFICATIONS: -_ (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ` f Septic ank: Disfance from nearest well---- '�_-.__Disfa[e from `oundatioq_.__t_f _p____.Material-_.._____? 'e--*------------ No. of compartments--------"y----------Size-_ __--�---X�r--- - Liquid de th----- --- -------------Capaci#y_l -pp- Dispos Field: Distance from nearest well.----54'___Distance from foundation____1g/--__.-.Distance to nearest lot line -�`--------- Number of lines----------- ------------------Length of each line-----tAV..------------.Width of french---- ---`-.------------------•-- Type of filter material-------- ---Depth of filter material-----�'-�_`�--------total lengfih____- ----------------/---- Seepa e Pit: Distance to nearest well -- d-�_-Distance from foundation-___L_Q_--______.Distance #o nearest lot line___~�---------- See Number of pits.------------------Lining material------5-1./-�1-----Size: Diameter------3.3-'------Dept h__�.'S_�----------------- ma Cesspool: Distance from nearest well------- from foundation------------------Lining Cat tial gals. ❑ 5i7e: Diameter------ ----Depth----- ---- -------- --- --- ------ - -------- q p y--------------------------- - Privy: Distance from nearest well---------- ----------------------------------- ------ F1 ---Distance from nearest building--_------------------------------- ------ --------------- ------------ ------------------------------------ Distance to nearest lot ine---------- - --- ---------------- --------- --------------------- ----- Remodeling and/or repairing Idescribej-----------=--------------------------------------------------------------' -- - ------- ------ I here-by certify that I have prepared this applica+ion and that the work will be done in accordance with San Joaquin County ordinances,FS� atlaws, and rules and regulations of the San Joaquin Local Health District. ed} -- --- - -------L,",rm ----------- (Sign .. n r r Contractor) .. er a d/o C + for -- _ ------ - ------- ------------ �_ - - -(Title)-------- --- BY=-- - ------ ---• ----- - (Plot plan, showing size of lot, location of n relation to wells, buildings, a+c., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------ _/. DATE__,- --/_1_------------- ------------- DATE - REVIEWED BY------------------------------------------------------------------------------- --------------------------- ------------ ---."--------- --------------�--------- BUILDING PERMIT ISSUED------------------ ------------------------------------------------------------------------ -------- DATE- Alterations and/or recommendations:___ --------------------------------- - ---------------------------------- ------- ----------- '--------- ---------•----------------------------•--------------------------- _-_-_-..----_--- ------------------------------" -- LDate./_/ Lc1 --------- -I-------- ------------ ----------- FINAL INSPECTION BY-- -- ------ - -- ------ ------------- - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. Soo West Oak Street 124 Sycamore Street 205 West 9th street Stockton,California Lodi,California Manteca,California Tracy,California F.P.Ca.