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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 Ap�_lication is herebymade to the San Joaquin Local Health District fora permit to con stru an al! the work herein described. This application.i made In compliance with County Ordinance No. 549. JOB ADD SS LOCA ION..I;Ic--' +�ri1- 7f'tr ----- 01'., --- �.cz� Owner's W-A --- Phone---------------------- Address----- ---,r- -__ ---------•---- -•--•------------- Contractor's Name.-.-__._yp - _� Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-.__- Number of bedrooms ._7e_-'_"'Number of baths ---4- 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 ❑ Previous Application Made: (If yes,date-- -----------------) No ❑ New Construction: Yes ❑ No ❑ FNA/VA: Yes ❑ No ❑ �-- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) � ` s Septic ank: Distance from nearest well-.-,'Sp ----Dista cJe fro foundation-_---/_0--- ------Material----- ---------------- ' No. of compartments--------�^---------.--Size ��r- ----5------Liquid depth_.---�-----------------Capacity-_1j-�-------- i Disp�Field: Distance from nearest well____*?D_fyL Distance from foundation__._Q__i._______.Dlstance to nearest lot ______ Number of fines---------/------------------------Length of each line------ ------.. ----- --�a4- - Width of trench �-.--------------- Type of filter material----s,a ---------Depth of filter material--,.__-)j-----------Total length_____J.847___________________________ Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------_--- Distance to nearest lot line_-._----__-_----_ ❑ Number of pits----------------------Lining material----------------------.Size: Diameter-----------------------Depth-.---.--------------------- ---- Cesspool: Distance from nearest well-----------------Distance from foundation-----.--------------Lining material---_---------------------_---------C! ❑ Size: Diameter.-------------------------------------Depth---------------------------------------------------.Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------_.t-------- ❑ Distance to nearest lot line-------------------------- ------------------------------------------------------------------------------------------------ ---i------- . Remodeling and/or repairing (describe)______________ ___ __ _ --------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I ave prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, rules and regulations - e San Joaquin Local Health District. (Signed)-------------------- ---- - --------------- -------- r and/or Contractor} --- --- . . BY:---------- --- -------------1--------------- ----------------- -��-----------------------------Title} (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--- - T DATE +%-- - ---------------------------- REVIEWEDBY---- ------------------------------------------------------------------------------------------------------------------------- DATE-----------------------•------------------------------------ BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE.------------------------------------ ----------------------- Alterationsand/or recommendations--------------------------------------- --------------------------------------------------• ------------•------------------------------------------------------ -------------------------------------------------------------------------------------- -----------------------------------•-------------------------------------- -----------------------------•---------- -----•----------------------------------------•----------------- ---------------------------------------------------------------------------------- -------------------------------------------------------------------------- FINAL INSPECTION BY:.� ,1. ------ -------- - Date... Q �� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Avs. 300 West Oak Street 124 Sycamore Street 205 West 9th Street r Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.00.