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- FOR OFFICE USE: 2 O l + 0 1 ` _______.___________________.____-_-______________- APPLICATION OR SANIT TION PERMIT Permit No. ./h�.._ -�`S_ --------------------- -------------------------------- (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 application is made in compliance with Co t Ordi eNc. JOB ADDRESS AND LOCAT ----- Owner's Name ------ ---------- ------ Phone.................................... Address-------- ----- - -- --- D ��I•C� Contractor's Name --- ---------------------------- ---------- ----- --------------- Phone................................... Installation will serve: Residence [ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: -------- Number of bedrooms ----- Number of baths __-__.._ Lot size Water Supply: Public system ❑ Community system Private ❑ Depth to Water Table ------ ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Z Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: (If yes,date--------------------) No 9 New Construction: Yes ❑ 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-AMY---Distance from . lur*tion �4_-__.__._.Material_;r -MNo, of compartments________ _ C . 6X ___ --__Size__ _ '_.X__4X44wd depth____4_e_.__._____ y__.,V _ 9?, Disposal Field: Distance from near weII� Q -_Distanpe from foundation_�,,19___.......Distance to nearest lot lir�/�-________ Number of lines._ _ __-_ _�.__�_ ___.'�._�Length of each IineJ2 4o?-/(.__-Width of trench-.__�y___________________ Type of filter material_/_t,,'t �epth of filter material Total length �f� -------------------- Seepage Pit: Distance to nearest well---------------------- from foundation-------_------------Distance to nearest lot line_.._.-_.___.-_.._ El Dumber of pits--------------------Lining material-----------------------Size: Diameter-----------------------Dept h------•----------------------_. ti 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):--- -•------------------------- ----------------------------------------------•---------._- --------------•-------- ----------------------------------------------------••------------------------------------------------------------------------------- --------------------------------------------------------------- --------------------- ----- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and ules and regulations of San Joaquin Local Health District. (Signed) ------------------------------------------------ -----------(Owner and/or Contractor) By:-------------------------------------------------------------------------- ---------------------------------------------------------(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 APPLICATION ACCEPTED BY------------------------------------------------- ------------------------------------------ DATE--------------------------- REVIEWEDBY----- --------------------------------------- -- ----------------- ----------------------------------------------- DATE-----------------------.......... ---------- BUILDING PERMIT ISSUED---------------------------------------------------------------- ------------------------------------- DATE-------------------------------------------K=-=--------------- , Alterations and/or recommendations:---------------------------------- ----------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------ ----------------------- ------- --------- -------.. ------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------ -------------------------- -{------------------------------- FINAL INSPECTION BY:. -------- --------------------'� Date---------�_�_'_ '!- '_br•J SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.CO.