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APPLICATION FOR SANITATION PERM PermXo. . --------------------------------------------------•------ (Complete in Duplicate) &07 ----------------------- ------------ --------- -m--- I This Permit Ex ires 1 Year From Date Issued Date Issued 4;4.2< _--- ' 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 CounVrdinance No. 549. 9V_te JOB ADDRESS AND CATION--- --•----- Om -•-•---- . -- -- --- ---------------- ., M.m --------------- Phone--------•--- Address--- . --------- -------- ------------------ -- _ -----------••••--------•---------------------------•---••---••-----•--..._-•-•-- Contractor's Name ----.. Phone................ Installation will serve: .Residence of Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _.___ Number of bedrooms __ _ Number of baths __ Lot size ----- _...__ ._ -�--_- Water Supply: Public system 0 Community system ❑ Private El Depth to Water Table ........ ft.--- _ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑J 1 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 within 200 feet.) SFptic Tank: Distance from nearest well_________________Distance from foundation___----______...___-Material-----_............No. of compartments-------------------------Size---- .........-------------Liquid depth---------------------•---Capacity ,- Dispo�a] Field: Distance from nearest well__ ----Distance from foundatio '� /-`�'j -+�------•• r�.,y ........Distance to nearest lot line___S_....-- Number of lines----__..____" ----------------Length of each line------ Q_� _____-;.Width of trench.__ � Type of filter material.__-,/.?�p _ .--Depth of filter material____.IY':,---------Tota! length.___-. --_-- :_____: f ------ Seepage Pit: Distance to nearest well----------------------Distance from foundation----------- ..__..Distance to nearest lot line......_____.----- I ❑ Number of pits_____________________Lining material-----_--------_..__----Size: Diameter......__-.___----------Depth__....----•--------.............. , Cesspool: Distance.from nearest well_________________Distance from foundation--:._._._-_...____..Lining material ____---______._....____. _ d Size: Diameter-------------------- -•--- Depth--,.---------------------------------- ------.Liquid Capacity_._._... gals. � Privy: Distance from nearest well -------_----_________------- --_---_Distance-from ni ares-'buiidin�q�. ❑ Distance to nearest lot` line... t = 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 ordinances, State laws, and rules and regulations of the San'Joaquin Local Health District. (Signed) -- --------- ---------- -- --- ----- --------_---(Owner and/or Contractor) BY� 4 -------------------1`--- -------------------- {Title)-----------------•---------------------------- - P of plan of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY _-.—APPLICATION.ACCEPTED BY- - - – r. DATE_. = ~ _y------------- REVIEWED BY-------------•--••----------------••--------------- ----------- -------------------------------- ----------•--_------- DATE BUILDIN PERMIT ISSUED-------- – DATE Alterations and/or recommendations:._-__- __.___._-. --- --•---•----•-•--•---------------------•--•------•-------- --- I -------------- ------•----- ------- .._... --•----- --------- ---- •------- Q FINAL INSPECTION BY:.. r ------ -------------------- Date--- '. ` .�`� ............ •------------- --------•- SAN JOAQUIN LOCAL HEALTH DISTRICT i 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California . Lodi,California Manteca,California Tracy,California ES 9 REVISED 8-59 2M 5-61 ATLAS