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FOR OFFICE USE: -------------------=- - - --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. - ---------- (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 7 No. 549. 1, JOB ADDRESS AND LOCATION ------- E-4..:_ � •,.. _ ............. 46 /� Owner's Name •----------_'_:v__`_ f -{ =G --------- =� ----------------------------- Ph ne -•------•--•--------•------`_-- - `� Address---------- ---------------------•- J�' -------�---------------------------------- • - .......... Contractor's Name 1 -s�_� Ph'ne------•--•----•-----•---•--•----•-- Installation will serve: Residence Apartment House ❑ Commercial E] Trailer Court E] Motel ❑ Other El Number of living units: __.--__• umber 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 ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date____________________) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available lvithin 200 feet.) SepticTank: Distance from nearest well__ ____4_ _Dista fr founda ' n__.l_�.'___._ ..Mat�er}'°I _ ___ ________ _______________________________ No. of compartments____-_-.-____.--___Size--?'.-A. ___,-Y.Liquid depth-----------T----' _______Capacity_ ;4!;:!_'�=__-__- Disposal Field: Distance from nearest Fwell---IP4Q _Distance from foundati,.�'_ �__t�?_... _.Distance to nearest lot ine___ -_-__- ❑ Number of lines-__-___�_,_ ,___________Length of each line �7'J _".f Width of trench-- -�.`____________________ s r S Type of filter material.-5-j_j� td Depth of filter material_____.-._-.-____,_-Total length.............r„j-_ ....._....._....__.. a Seepage Pit: Distance to nearest well-------_--------------Distance from foundation--------------------Distance to nearest lot line---_______--__--_ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- ❑ Size: Diameter--------------------------- ------Depth----•------------•--•-------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well----------- ______________ g..____._._________.____.._-_ ___•__________________Distance from nearest building _.-.__ ------- ❑ Distance to nearest lot line---------------------------------------------- ----------•------------- •---------------------- Remodeling and/or repairing (describe):-----------------.------------------------------------------------------------------------------ ................---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- --------------------------------------------------------------------------------------------------------------------------=--------------------------------------------------------------------------------------------------- V1 ----------------------------------------------------------------------------------------------•-------------------------------------------------------------------------------------------------------------------- --------- I hereby certify that I haveprepared this application and that the work will be done in accordance with San Joaquin County ordinances, St ws, and rules r ulations of the San Joaqu' ' ocal Health District. �46-v ----------------------------------Owner and/or Contractor By:----------------------------------------------------------------------------•-------------------------------------------------------(rifle)---------------------- --------------------- -- (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--------------------------- ---------------------------------------- /r TE---------------------------------------------------- ---- REVIEWEDBY---------------------------------------- -------- ----T I 1--- ---- -- D T BUILDINGPERMIT ISSUED-----------------•--------------------------------------------------------------------;---------- ------------------------------------------------------ Alterations and/or recommendations--------------- ------- ------------------------ -------------------------•-- -------------------------------------------- --- ----- 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 ES 9 REVISED B-59 3M 3-'63 F.P.CD.