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FOR OFF16d= Car&q -t I ------------------------ APPLICATION FOR SANITATION PERMIT Permit No. a .� --------------------------------- --------------------------------------------------------- (Complete in Duplicate) �i .—rf 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 compl'ance with County Ordinance too. 549. 4 JOB ADDRESS A LOCATIO !I-.l 7-------cc� ----------------------- --•------•-•------•---------- -- --------- ----------- Owner's • ------- ----- - --- ------------ t '- Ph ----------- - j Contractor's Na Cf / ��U� --------- one---•----- r Installation will serve: Residence P�f Apartment House ❑ Commercial ❑ Trailer Court ❑ otel ❑yy Other ❑ Number of living units: __-I-__ Number of bedrooms J_-_ Number of baths -__l__ Lot size --- ---- ________-__._ Water Supply: Public system ❑ Community system 0Y Private ❑ Depth to Water Table _-M- 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 [T New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public s wer is available within 200 feet.) r Septic Tank: Distance from nearest well__1 �I_ Distapge�f�TOP foyp�tigp----1f�__---------Mate�i��_!_= No. of compartments__.-._ Z_____..____Size. ..1_'Y_ _ Liquid depth----- __c_Y_....._. ----Capacity_______: -__. Disposal Field: Distance from nearest well_./P'__/Distance from foundation.11!'--------Pistance to nearest lot li--_________ne..�1__________- Number of lines-.----- _ Length of each line�_ _s _ _ �.Width of trench_______ ____ __________ Type of filter material__l�___ �_ pth of filter material_____ _ _ ________Total length______ ---------------1. _7�, Seepage Pit: Distance to nearest well.---------------.-----Distance from foundation_-----------------Distance to nearest lot line---------------_ 5' ❑ Number of pits_____________________Lining material-----------------------Size: Diameter---------.-------------Depth--------------------------------- 01 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_____________________--______-_.___-_. ❑ Distance to nearest lot line-------------------- ------------------------------------------------------------------------------------------------------------------- Remodeling and/or repairing (describe):------------------------------------------------------------------------------------------------------------------------------------------------------ .e -----•---------------------------------------------------------------------•--•---------- --------------------•----------------------•-------------------------------------------------------------------------------------- -------------------------------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------UJ ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------ 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 Joa Local Health District. tX1 (Signed) !X 11_ r1,j `�"_- _---°----- --- ---- ----- _._____.____.____(Owner and/or Contractor) B ___(Title)_ (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY---------------------- ----- -------------------------------------------------------------- DATE--------------------- ------------------------------------ REVIEWEDBY-------- ----------------------------------------------------------------------------------------------------------------- DA�--------- - - ----- --- --- -- BUILDING PERMIT ISSUED--------------------------------- ------ -----. DAT ----- -- . r�•f �'- ------- Alterations and/or recommendations-----------------------------------------------------------------------------------------=-- i"--------------------------------•------------- ----------------------------------------------------------------- ----- --------- --------------------------------------------- --------- -- -------------------------------------------------------- --------------------- ------------------------------------------ -------------- -------------------------------------------- --------------------------------------------------------- ------- ------------- - ------------- ------------- ----------- --------------- ------' --- �r,1 , FINAL INSPECTION BY:-- -`-----`-- -- - Date---- --------- �`-'----------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.