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rUK (JI-1-ICE USE: - � ----� ----------------------------------- c� ' ______________________.__.___..________-.__..__._:_____ APPLICATION FOR SANITATION PERMIT Permit No. . _�__� ! I ------------------- ------------------------ ---------- (Complete in' Duplicate) I -- ----------------- This Permit Expires.1 Year From Date Issued 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 compliant ,wi ounty Ordinance No. 549. OSS—d —1 z JOB ADDRESS AN OCATION. � ' - !/ - .T_^^--- -- Owner's Name /•------- --- ----- �a f��r --- Phone------------•---------------------- ---- --------------------------------- Address------ •------------------------------------- ------------------------------------- Contractor's Name ----------- ----•---•- ------- -•--- -------- "' '�---------- Phone Installation will serve: ResidenceApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ElOther ❑ Number of living units: ---/.- Number of bedroomscS?___ Number f baths '72"" Lot size 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 ❑ h� Previous Application Made: (If yes,date.......................) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF'INSTAI.I_ATION AND-SPEC1FICATIONS:="`�" (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic ank: Di .. O p stance from nearest well_______ _______Distance i foundation---------_----._ Material__. ! ' --------. No. of compartments------- -_----------Size 6__Xy_-X �,___Liquid depth------ _�_____---------Ca acit �a_d_ _ ___ P Y--� Dispos Field: Distance from nearest ___._Distance from foundation_.:.40__ __.__.Distance to nearest lot line__r__- . Number of lines_)_.______._ _________Length of each line___ `4.�.__ Width of trench_�_-_________________________ nn 1� Type of filter material_._�l--------__-°_' Depth}of filtdr materialf _�__-.__._Total length___._ !?_�_______________________ (`� 3 Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of its...._____..__.__ p ---Lining material-- ----- - Size: Diameter--------- -------------Depth-- -- --------------------------- _ Cesspool: Distance from nearest well"______..___.__`t Distance from foundation___ ------------Lining material-_.______..-----_.__..___.__._____- _ --- 3 ❑ Size: Diameter_ _'_____________ a- -_-------Depth--------- - -------------•-- -------..____________Li quid Capacity I. Y------------------- ----gals. !r t Privy: Distance from nearest well ______________r_____.._____._..___:----------Distance from nearest building___-.________.__-..__________.___..___.._. ❑ Distance to nearest lot line ✓ x - - Remodeling and/or repairing (describe)----------------------------------.--------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- '� --------------------------------- - -----------------•------------------------------------------- -------------------------------•------------------------------------------------------------------------------------------------------------------------------ ----------------------------------------------------------------------------------------------- ------ ------ ---- -- - --- ----- I hereby certify thatave prepared this application and that the work will be done in accord ance with San Joaquin County ordinances, State laws, ules and regulations of the San Joaquin Local Health District. (Signed)------------------------ ----- ------ -- •------ n /�Contractor) By:-- ---------------------------(Title_ --------- (Plot plan, showing size of lot, location of system in relatio to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY �+ APPLICATION ACCEPTED 13Y ------ r ---------------------------------------- DATE----- REVIEWED BY--------------------------------_ - ----------------- DATE ---------- ----- BUILDINGPERMIT ISSUED.------•--------------------------------------------------------------------------------------------- DATE------------------------------- ----------------------------- Alterations and/or recommendations------- ------- -------------------------------- ----- ------------------------- --------------------------- -------------------------------------------- -------------------------- --------------------------------------------------------------=----•---- ------------------••------•----------•------------- a -----------------------------------------------------------------------=--------------------------------------------••----------------------------------•-------------- •-------------------- •--------- ----------------------- ------------------------------ ---------------------•-------------------------------------------------------------- ---------- ------------------ - I FINAL INSPECTION BY:..... c ------------------------ Date---------------- -'- ---------------------------=-- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 4 124 Sycamore Street 205 West 9th Street Stockton,CaliFornia Lodi,California Manteca,California Tracy,California F._t__. i