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FOFFICE USE: )� _.7 7. s- ^ APPLICATION AOR SANITATION PERMIT Pe�init No. - _.... ' - f -------------------------- --- -------------------------------------------------- - � �(Complete in Duplicate) S�Z bate 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 Ordin lce�Noo. 5449. ` JOB ADDRESS AND CATION-------------------------- ------ == -- --------- ---- ------- --- --------------------- Phone- Owner's Name------- -- ---"""-" -_ Address ----------- =- ------ Contractor's Name-----•--••------ .. Phone Installation will serve: Residence [Apartment House ❑ Commercial ❑ TrailerjCourt ❑ Motel ❑ Other ❑ Number of living units: ___/_ Number of bedrooms __/ Number of baths __/_.Lot size ____-" ___' -.. - ---------------•- Water Supply: PublicFsystern Community system ❑ Private ❑ : Depth to Water,Table 4-4 ft. Character of soil to a depth of 3 feet: ��1�(] Gavel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ' Hardpan ❑ l Previous Application Made: (if yes,date__-t- -) 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.) ��p &j /�'"`'_Distanc fromfoun tion_-. __.Material____ - -r_________________________ Septic Tank: Distance from nearest well_-_______ /D----- No.�of compartments----- --------------Size_ --- ------•Liquid depth_____--------------Capacity e? --• Disposal Field: Distance froni'nearesf well------------------Distance from'foundation--------------------Distance to nearest lot line_______--___-____ Number of lines`->------------------------------Lengfh of each line------------------------------Width of french----------------------------------- �� Type of filter,material---------------------------Depth of filter material-------•---------------Total length------------------------------------------ � a Distance to nearest well--------------_-------Distance from'foundation--------.-----------Distance to nearest lot line----............. Number of pits-" ------------------ Lining material------------x.-_------Size- Diameter--------------------___.Depth---------------------------:--- ., - ;_ t Cesspool: Distance from nea`ra`st,well---�_____=___-Distance from foundation____________________Lining material__-_______.-_�-._____________._____. �• Size: Diameter - --------- „ _ _~De th-------------------- --gals., / ❑ p ------------ ----------------Liquid Capacity- ---------------------- g � Privy: Distance from nearest_well-.____-.-__ ________________-_-__________Distance,from,neare� building------------------------------------------ P f ❑ Distance to nearest lot line--------------------- ------------------------•-------------------• -----4 ------------------------------------------- and/or repairing [descriUe):_-- ___-- --- ------------------------------------------------ Remodeling ------=------ - -------------------- t — ------------------------------ -- y ------------------------ ---------- I hereby cert' that I have prepared this;application,and'that the work will be done in accordance with San Joaquin County ordinances, St la s, and rules arid-regulations of fhe;San Joaquin Local Health.District. i s� (Owner and/or Contractor) (Signed)-------- - - gY: = - • i --------- -- - -- - ----- �`- -----------------------(Title)-- ±---------- ---------- --- --------- (plot plan, showing size of lot, location of system in relation.fo wel , buildings, etc., can be placed.on reverse side). - t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY t = ti= - ------------------------- DATE-----"T' �-/ �-- --------------- REVIEWEDBY------------------------- --------- --- --------------------------------------------------- ----------- DATE-----------"------"---------------------------------_------ DATE------------------------------------------------------------ BUILDING PERMIT ISSUED-----------1--•------------�---- --------------------------- ------------------------------------- . it Alterations and/or recommendations----------- ----- -- ---------=------------•--------•-----------•-•---------------------- ----------------------------------------•-------------------------------- - _____________________________________4-__________________-___-._.__.__._______. ___________-_-_--____-._-__________________. ___________________________________________________________________________________ i -------------------------------------_---------------- _---- ___---------------- _------------------------------------------ _------------------------ ------------------------------------------------------------- --------------------- -------------- == - ---- __________ _________________________________x -_______-____-----______--_-_____.-----------------.--------- -_----------------------.________ FINAL INSPECTION BY:------ l� � -------------- S Date------- I Srestook QUIN LOCAL HEALTH DISTRICT k 1601 E.Ma:elton Ave. 300reet 124 Sycamore Street 205 West 9th Street Stockton,California I Lodi,California Manteca,California Tracy,California E5 9 FMV19ED 0-59 3M 3-•63 F.P.L'D.