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01 APPLICATION FOR SANITATION PERMIT Permit _ ----•--- (Complete in Duplicate) Date Issued _A61 ereb made to the San Joaquin Local Health District for a permit to construct and install the work herein described. Application is hereby q This application is made in compliance with County Ordinance No. 549. p� -�---�- f -------•--------------------•-----------.-------------------•------------•--- JOB ADDRESS AND O ATION----.��-Q-- -=------ Owner's Name----- +�� Phone Address-... ------------------------------------------------------ -----=... ------------------- --------------- Contractor's Name --._.- Phone------- ------ --------------- -- --- ------ ° -------- --- --- -- ------- Installation will serve: Residence'El Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: 44--- Number of bedrooms _4--_ Number of baths __ - Lot size _- -_ ---- _--_------------------------------------ Water ---------- ------Water Supply: Public system &_`Commuriity system ❑ Private ❑ Depth to Water Table -_fit Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay A--Adobe❑ Hardpan ❑ i Previous Application Made: Yes ❑1 No P!r New Construction: Yes ❑ No k�' FHA/VA: Yes ❑ No gj— 4 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or'cesspool permitted if public sewer is available within 200 feet.) 'ic Ta Distance from nearest well-----------------Distance from foundation_--------_-_---_...Material---.---- --_---------_-_______-------- __---. t ❑ No. of compartmenfs--------------------------Size----------------------------:---Liquid depth------------------------- Capacity-----------••---------- + sposal Fi Id: 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 filter material----------------------- Iength---_--------------------------------_-_--- -/ ,0 Distance to neare of line Seepage Pit: Distance to nearest well-4w- --------Distance from fou ation-- __ --_..__- �I Number of pits------/-------------Lining material/ -Size: Diameter---_Z4"-,r..........Dept h Cesspool: Distance from nearest Well-----------------Distance from foundation-.-------------.--- Lining material--------------------------___ -Size: Diamefer---- ----------------------------------Depth---------------------------------------------- Liquid Capacity gals Elj -------___Distance from nearest building Privy: - Distance from `nearest well ----- --�--- ------------- - 9----- ------------------------- --- ❑ Distance to noa`rest lot-line--------------- •--------------------•- -------------------- ' --------- -- r Remodeling and/or repairing (describe)------------`" " ! F ----------y-------------- ------------- -------------------- -----------------------------•---------•------------ ---- --------=--------------•---•---;------------•------------------------------------------------ :I 1 --------- - --------- ------- -- -------------- --••------------------------------------ q Y I hereby certify`that I have prepared this-application and that the work will be done in accordance with San Joaquin Count ordinances, State laws, and rules and regula ions of the San Joaquin Local Health District. -------------------- Contractor) , (Signed)..---------------- (Title)-_----- - - -- --------------------------- (Plot plan, showing:size at, location of system in.relation to wells, buildings, etc., can be placed on revers ide). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-------------------- --- DATE <------------------------------- 1!!� ------------- REVIEWED BY ---- DATE --------- --- BUILDING PERMIT ISSUED = ---- ---- DATE �r Alterations and/or recommendations----------------- y --------------- - -----------------------•--------•-------------------- ------ Fa --._.:"} -:_._ - - ----------------------------------- ' --------------------------------\J -- -- •------�------•-------�-- --------------- --------------- --.... . ---------------- -------------------- --------------------------------------------------------•---------- �. FINAL INSPECTION BY:---= -------------- -- Date-- --- I-------------------------------------------- F ► SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 132 Sycamore Street 814 North "C" Street Stockton, California Lodi, California Manteca, California Tracy, California ES-4-2M , Revised 1.57 F.P.CO.