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FOR OFFICE USE: --------------------------------------------------------- _____________________--____-_--___.----_____ ______ APPLICATION FOR SANITATION PERMIT Permit No. .. ._..� ----------------------------------- ----- ------ -- (Complete in Duplicate) Date Issued ......................................................... This Permit Expires 1 Year From Date Issued a CC C? 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 th County Ordinance No. 549. tp_,770s6 X, r .JOB ADDRESS AND L CATION- �d� ---- 1- --- : ;-- . Owner's Name----- - - ------�_11L: ----------------------------.--------------------------------- --. Pone----•-------•-------- Address._....... --• •----- ----- ...... Contractor's Name------- --- ----------------------- ----------------------------------------------•------ Phone----------------------------------- Installation will serve: Residence Z_Kpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: . . -.-. ... Number of bedrooms - Number of baths . '_. Lot size 101,-4 s-/_3_.�......................... 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----- --------- ) No 'New Construction: Yes ❑ No [g--FHA/VA: Yes L�_—No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank- Distance from nearest well-----------------Distance from foundation----_-_--_.-_.._.Material.-----------------------------------------_..--. , No. of compartments--- - -------- ----- ----Size------------------------- ------Liquid dep'th--------- - -- ----------.Capacity----------------------- Disposal Fi ld! Distance from nearest well-----_-�------Distance from foundation..l47_._..-.Distance to nearest lot line..s,-.�___-- Number of lines_-__--- - �-. g 2�- It Width of trench- -... _. Length of each line-2-41-1 �j --.--.. _ Type of filter material_ Depth of filter material-.-A-------------- otal length__. 1:2_._. _ Seepage Pi Distance to nearest well_____.'-r...._Distance from fo ndation_-��"_-....Distance to nearest lot iine_.::r_ .. �+ a Number of pits...../....----- --Lining material-�ff ...Size: Diameter, y...___Depth ' ��01 �f' Cesspoo: Distance from nearest well-----------------Distance from foundation--_-.---- ------ _Lining material------------------------------------- El .......---. _....._-----❑ Size: Diameter- -- --------- -- -- ------- -------Depth----------------------------------------------------Liquid Capacity---------------------------gals d Privy-, Distance from nearest well----------------------------------------.- - - ._Distance from nearest building-.----.-------_---....._------...:_:7r `fir ❑ Distance to nearest lot line.- __-, - - -------- Remodeling and/or repairing (describe): 121 --------•-----------------•-------------•-•---------------------------------------• G� --------- ------------------ --------------------------------------------•---•------------:------------------------------•-----------------------------------------------------•-------•------------------- J --------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ --- ------ fl 1 hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County C ordinances, State laws, and r es and regulatio s of the San Joaquin Local Health District. (Signed)--------------- - -------------.( or Contractor) . S� By--••--------•-------------------------------------------- ----------------- -------------{Title) `--------------- (Plot - - -- - -- -------- ------------ - -------------- (Plot plan, showing size of lot, location of system in relat' to wells, buildings, etc., can be placed on reverse side). r FOR DEPARTMENT USE ONLY APPLICATIONACCEPTED BY--------------------------------------------------------- ---------------------------------------- DATE------------------------------------------------------------ REVIEWEDBY--------------------------------------------- --------------------------------------------------------- -------------------- DATE-------- --------------------------------------------------- BUILDING PERMIT ISSUED----------------------------------------------------------------------------------- ------------------ DATE-------------------------- ------------------ --------------- Alterations and/or recommendations------------- ---------------------- --------..----------------------------------------------------------------------------------------I---------------------- -•--------------------------------------------------•-------------------------------------------- -----------------------•---------------------------------•---•-----------------------------------------------•----------- ------•----------------------------- --------------- - ------------------------------- ------------------------------•-•--- •------------------------...---------------------•---------------------------------------------- ----------------------------------------- -------------------------------------------- ------- ------------------------------------------------------------------ FINAL INSPECTION BY:----- ...... ------ - Date. -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Mazatlan Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi,California Manteca,California Tracy,California