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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit Not--------------------------------------------------------- -------•-- --------------- --- -------------------------- (Complete in Duplicate) ------------------------------ -------------- This'Permit Expires ] Year From Date Issued Date Issued t 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. ,. ., .3. JOB ADDRESS AND LOCATIO .- _ `! - -- - . Owner's Name-------------, - Phone --------------------- - Address-:....._. - ------------- , --------------- I r _ _ - . ..............Contractor's Name-------- ------------------------------------------ .... .. .. . Phone........... -_--------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number offliving units: I---- Number of bedrooms _ _ Number of baths f.... Lot size .............................. Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water TableiArft Character of soil to`a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam`❑ Clay ❑ Adobe R3--Kardpan ❑ i Previous Application M6de: (If yes,date---------___________) No [ ""New Construction: Yes ❑ No p�FHA/VA: Yes ❑ No [9— TYPE 9 —TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank orcesspool permitted if public sewer.is available within 200 feet.) Septictic Tan : Distance from nearest well____.___-'-= ----Distance from foundation--------------------Material _____________________ _____________._.__-_..__ /maxT/ compartments s_____ _l_ _ .Size_______________________-----__Liquid de th_______._-____- -______._Ca acitY----------------------- Disposal Field: Distance from nearest __-_Distance . t from foundation___41�_�._.--Distance to nearest lot line__ �__- Number of lines.__.__`______._�,.______-___ Length of each -----------Width of french---. --�_____________________ -Type.of filter material_/ _!L_f �Depth of filter material-----,06� _____Total length____� ��_ _____________________ j Seepa p,,Pit: Distance to nearestjwell _ " ._____Distance fm foundation to nearest lot line_ _____ ® Number of pits____, _+:_______Lining material_ _ ._e __-Size: Diameter_~ _.__...___Depth__ ____'________________ Cesspool: Distan e•.frtimanearest well_________� m n _______ _ ---------------- material-------------------------------------- x ❑ ----- -- ----------------------------Depth------------------ ------Liquid Capacity... --------•-----------• --gals. WWW Privy: Distance raom nearest well-------------------------------------------------- from nearest building----------------------------------------- ine --- -Distance Remodeling and/or repairing (describe): rel -- ------------ --- " ------------------- i T ' ------------------------------------------------------------------------------•---------------•------------------------------=--------------------------••---------------------------•----•---------------------------_------- 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 r gulations of,Jhe San Joaquin Local Health District. (Signed)_ �-----` 2 9 - - ---------------------------------------------(Q_wjte�t�flr Contractor) SY (Title)----6"w-//Y� (Plot plan, showing size of lot, location of em. in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED i3Y___ .,..r _ - ---�---�--`--------------------------��'------------------------- ---••---..._ ... DATE------ �-'--`-�`S'�=--�I--------------- ----�-�-- r REVIEWED BY-------------------------- ------------------ . DATE---•----.---•- -------------- BUILDINGPERMIT ISSUED-------------------------------------------------`--------------------------------------------------- DATE-------------------------------;-- ----- ------------ x' Alterations and/or recommendations:__l_st------- _-- - ----- �C -. ` SZ--------0-V----------- --------------------------- --------------- -------------• - 4 ------------------------------------ .......... -------------- --- FINAL INSPECTION BYf' - ------ Date---- ---._ � 1_.. SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street} ; 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California + - Mant ca,California " Tracy,California t e8-9 peviseo 6-59 r.P.eo,x,n a-eo �