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FOR OFFICE USE: ---------- ------------------------------- ------- --- APPLICAT)ON FOR SANITATION PERMIT Permit No. ....... ------------------------------------- -- ------- ------- (Complete in Duplicate) Date 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 Ordinance No. 549. ;,} JOB ADDRESS AND LOCATION '?- - r --• = = -'---`----=--------------------------------------`---------------- j Owner's Name --------- Phone----------------- Address-----------------------------------------------------------------------------------------------------------------------------------------------------------------------•--- �--------------••-•---- Contractor's Name_. fix.. --••• � f 4 Phone.---y-'------------------------ Installation will serve: Residence ® Apartment House ❑ Commercial ❑ Trailer Court '❑ Motel ❑ Other ❑ Number of living units: J__._ Number of bedrooms __ __ Number of baths ._. " Lotisize _--- ------------------------- Water Supply: Public system ❑ Community system El Private Depth to Water Table .rft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam CE Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_-_---------------] No ❑ New Construction: Yes ] No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: 1. (No septic tank or cesspool permitted if public sewer is available within 20fl feet.) Septic Tank: Distance from nearest wel1-67P___---Distance from foundatiori_ _ _________.Material- --':f' ..___ -_-_--.--._..-..----. r No. of compartments_____:""................5ize_'�"_`'f�_"_�:�..____Liquid depth----- ...............Capacity----------------------- Disposal Field: Disfance from nearest welly-~.......Distance from foundation- _--- __.--- _Distance to nearest lot lute_! __. __. Number of lines.---^------------------------- --Length of each line-------:-- ---_.----------.Width of trench--- -- �,-----------------.-- Type of filter material,s-,"��_*------..___Depth of filter material_._.. _ .Ff__,_.-Total length--_ __ ._-._________-_-_-_--_ Seepage Pit: Distance to nearest well _Distance from foundation--------------'__-.Distance to nearest lot line____-_.-___--.-_ ❑ Number of pits----------------------Lining material-----------------------Size^Diamei-er--- --- ,T------Depth-----..._.----------------------- Cesspool: Distance from nearest well-----------------Distance from foundation'-.._--,------- _ Lining material------_.____-_-__-_-----.-..--_------. ❑ Size: Diameter--------------------- ------____Depth----------- ----------------------------------------Liquid :Capacity----------------------------gals. Privy: Distance from nearest well------------------- _Distance from nearest building.-..-.--_..--------_----_------._---.____. ❑ Distance to nearest lot line------------------------------------------------------------------------------------------ ---------- ----------------------------------- Remodelingand/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 r ulation of the San Joaquin Local Health District. � (Signed)-- -------- - ----------- -r------- - - --- ----------------- --------------- -------------------------------------(Owner and/or Contractor) By--------------------------------------------------------------------------- ----------- ---------------------------------------------(Tltle)---------------------------------------- ----- ---------------- (Plot plan, showing size of lot, location df-system in relation to wells, buildings, etc., can be placed-on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.�„��.� ...-�= -- ------------------------------- --------------- DATE--- G REVIEWEDBY------------------------------------------------------- ----------- -- ------------------------------------------------------ DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED------------- ---------------------------------------------------------------------------------------- DATE------------------------------------------------------------ Alterationsand/or recommendations:--------------------------------------------------••----------------------------------------------------------------------------------------------------------- ----- -•----- -------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------------- FINAL INSPECTION BY:-_- ---------------- Date.... -- ----------------- ----------------------------------------- SAN - 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.co.