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FOR OFFICE USE: .2600-2) 52CO3rn aM1e I 1 t -_____________ _-__.__ -_____ . 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 No. 549. JOB ADDRESS AND LOCATION----- C------------------------------------------------------ ---(--e�- ------------------- - Owner's Name!, ----------------------------- ------------------ F ----------------------------- Address Phone.__. ---- ------------- - . __--'-----_ ---- ----- ----•-•-•------ -•-----------•--------------- - ------- ."tPhone----------------------------------Contractors Name - - - Installation will serve: Residence � Apartment House ❑ Commercial ❑ Troller Court ❑ Motel ❑ Other ❑ 61 Number of living units: _-1----- Number of bedrooms ---/--- Number of baths j____ Lot size ...�,_1-i ._]_�?_C'______________ ----------------- , Water Supply: Public system E] Community system,] Private E ] Depth to Water Table /_-�__ ft. 6 Character of soil to a depth of 3 feet: Sand E] Gravel\❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ d 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;bli)c�ewer is available within 200 feet.) Sep is Tank: Distance from nearest well__ _____Dista ro ;unda,ti /_C-_______-Mate ial__,•_ ` t- :C�• -- .--_______- v No. of compartments--_�_._._. -_ � ____X4q p, ---- Capacity.... z [ Size_____.____ X4- quid de th____.__`� Ca acit -__ i_C?_. Disposal Field: Distance from nearest weILG-7-__Distance from foundation./� ��___.......Distance to nearest lot_I�r�e.._ ___.___._ Number of lines------------- . Length of each line__' _ >_J_ _ /Nidth of trench_. .�_ -_.__________ Type of filter material_ --(-1 --,(-.Depth of filter material___-. ____--Total length_-____ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line-----.---.-..---- ❑ Number of pits--.-------------------Lining material---------------------._Size: Diameter---.________---_.___-Dept h--------------------------.--___- 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-------------------------_--------------- 17-1 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 County N ordinances, State;laws, and rules and r tion of the San Joaquin Local Health District. `mac_:/ 1 _ �/, C (Signed)---------- U - - (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 APPLICATIONACCEPTED BY-------------------------------------------------------------------------------------------------- DATE---------------------------------------------------------- REVIEWEDBY-------------------------------------------------------------------------------- -------------------------------------------- DATE------ ----------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE---------------------------------------------- -------------- Alterationsand/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