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FOR OFFICE USE: . - -------------------- Permit No. --------- - - ------------------ APPLICATION FOR SANITATION PERMIT ------------------------------------------- ------------- p -------------------- - a (Complete in Duplicate) Date Issued -- ------ ---- ---- - - - --- -------- -- 1. This Permit Expires 1 Year From Date Issued Application is hereb-- 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 0rdinanc No. 549. -�--------------- ------ JOB ADDRESS AND OCATIO ...._��--�-"� ----- �+ Phone------------------------------------ Owner's Name------ - - -r----- - . Address---- - - - ----------•------ Phone._ �! ...�"-."r��/ Contractor's Name----------------- ---•----------------- - ---- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: " --- Number of bedrooms ..�- Number of baths ./--- Lot size A Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table $A- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe❑ Hardpan ❑ I Previous Application Made:. (If yes,clate--._ ,--_..--) No ® New Construction: Yes ❑ No W- -. Yes ❑ No ❑ T—YT -E-OF�INSTAL-L:ATION-AND,SPECIFICAT-IONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Sep 4Fjd Distance from nearest well-----------------Distance from foundation-------------------.Material------------------------------------------------- i --------Size--------------------------------Li uid de th--------------------------Capacity...--- No. of compartments-------------------------- q p• DI Distance from nearest well..................Distance from foundation--------------------Distance to nearest lot line.._.....- -..".. Number of lines-----------------------------------Length of each line------------------------------Width of trench--------------.-----------------.--- Type of filter material-------------------------Depth of Vfer material-----------------------Total length---------.---------.-------e-}-,-�--------- -- foundation P' t Seepage Pit: Distance to nearest well/0 --r-Distance m foundation __.Distance to nearest lot line."----- ' ❑/ 1 Linin material---- QCT -- Size: Diameter----��.__�--�'----DePtn-------- --15=�-------- Number of pits----- -- ---- --- 9 �• I ----------- Cesspool: Distance from nearest well----------------- from foundation....................Lining materia------ als. ❑ Size: Diameter-- I-------------------------------- Depth----------------------------------------------------Liquid Capacity----------------------------9 __...Distance from nearest buildin Privy: Distance from nearest well-- --- ------------------------- 9 ry ..................".-.___... ❑ Distance to nearest lot line------------------------------ ---- --------------------------------- - ---- -------- I Remodeling and/or repairing Edesc I ----------------------"-------------------- I ----------------------------- ------------------------•------------------------------- k ---------------------------------------------------------------- - ------- --------------------------------- - ---------------------------------------------------------------------------------------------------- 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 an regulations of a San Joaquin Local Health District. 5i ned ---- -------------- r Co _ 0 s:: .. Owner an Contractor) By=--- -- ------------------------------------------------------ -- - ---- (Plot plan. showing size of lot, location of system in relation to wells, ildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY I APPLICATION ACCEPTED BY------- ------------------------- ----------------------- ------------------------- REVIEWED BY------------------------ ---- - --- --------------- DA E BUILDING PERMIT ISSUED- -------------•--------- ---------- ----------- ------------ ---------- ------- ---- DATE...----- .' ----------- ----------------- 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 F.P.c o.