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FOR OFFICE USE: ---------------------------- ---------------------------- --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ...� .. - --------------------------------------------------------- (Complete in Duplicate) This Permit Ex ires I Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to co struct and irk 11 he,work herein descrbe�_ This application is made in compliance ith County Ordinance No. 549. ,1 ',3 j�j os f`l JOB ADDRESS AND CATION---------)'x'.F - 6 � Owner's Name_.. _ _ - 7z - � - ----------- ----------- Phone-------------------------•---------- � -�r__ Address. ^-= Xn ------------------------------------- Contractor's Name----- �----_#Aptment t`� �- - ,�; e-------------------------- Installation will serve: Residence House ❑ Commercial E] Trailer Court ❑ Motel [:] Other ❑ Number of living units: I----___ Number of bedrooms _..1_..;;��aa__ Number of baths Lot size ___ ,e------`j`�_�-�_____________________._____ Water Supply: Public system ❑ Community system ❑ .'Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date____________________1 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.) Septic ank: Distance from nearest well_._ '[ -.Disfanc�e Ffm Bund t�n___� _ __._.Material__4% e' _,---.--------- _.________- No. of compartments____ ----------------Si iX Liquid depth______ ..._____ .Capacity__/(.� _ /II _ -- s f� Dispos Field: Distance from nearest well_! '_`-_Distance from foundation--- _ ___-------Distance to nearest lot Number of lines______,__ Leif th of each line____ __ _____.___Width of trench_____-_ 9 � , �� -: --- ------------ T e of filter material-, De th of filter material___.__ e _Total len th-_____ e-jo____________________ z YP �t-t-�- P �£-------� 9 � - C � See a e Distance to nearest well------►00 _____Distance from fa dation____ .._ Distance to nearest lot line-5. ___.____._v► Number of pits----- Lining mate�jaL•� _►_._ t,..Size: Diameter......73---------Depth___"1?_-- ------•---------- Cesspool: Distance from nearest well-----------------bistance from foundation--------------------Lining material------------------------------------- ; ❑ Size: Diameter------------------------- -------- -Depth------ Liquid Capacity -------gals. Privy: Distance from nearest well ____Y___________----------------- --------------Distance from nearest building__________________________-___________.._. ❑ 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 ordinances, State lawjarules and regulations of the oaquin Local Health District. (Signed)---------------------- ------------ f - ---- --- ----------------------------------------•-------------------(Owner and/or Contractor) By------------------- - ...-----••- --------- -- --- - (Title) :T (Plot plan, showing size of lot, location of system in relation t wells, build' , etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- - ---- ---- - DATE -------------------- ------- ----------------- - --------- REVIEWEDBY--------------------------------------------------x------,------:-----•----------------- ------------------------_------ DATE--------------------------- BUILDING PERMIT ISSUED-------------------------------- - ---- DATE---------------------------- ---- -------------------------------------------------------------- - -- ---------------------------- Alterations and/or recommendations:-------- --------------------------------------------------------•------------...----•- -----------------------------------•------------------- ------------------------------------------------------•-------------------------------------------------------------------------------------------- ---- ------ - ------- ------- ------- -- ---------------------------------------- ------------------------------------ ---------------------------------- ---- ---------------------------•--- � ---------------------------------------------------------------------------------------------------------------------------------•--------------------------------------------------------------------------------------- FINAL INSPECTION BY-.' y' Date_ ' 1"----y SAN JOAQUIN LOCAL HEALTH DISTRICT .0 1601 E.Haseltan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy, California E6 9 REVISED B-89 3m 3-'63 F',P.CC.