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a FOR OFFICE USE: Pit ill i ------------------------- c APPLICATION FOR SANITATION PERMIT Permit No. ................... -------------------------------------------------------- 3 ------------ ----------------- ------------------ ------- (Complete in Duplicate) Date Issued ..... _------------------------_-------__- This Permit Expires t 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 LOCATI ` ------------------------_--------------------------------•---•--------- -- ---- Owner's Na -- ------------ Phone---------------•-------------------- Address--------------- ------- ---- ----- •- _ ... os _ ---- ---- -- Contractor's Nam e......--------•-------• ---�-�--- -- - ---- - • -------•-•------- - - - Ph --•-----•--- --...----•�.. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units:/_ Number of bedrooms-3-- Number of baths z?2-- Lot size : /Y 4-0c, -------------- Water -•----------•- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table-Q ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy _Loam E] Clay Loam ❑ Clay ❑ Adobe.8f Hardpan ❑ Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ❑ N0 FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ante: Distance from nearest well-----------------Distance from foundation.------_.._--------.Material----------------_-----------_------.--------_.-.. No. of compartments------- ------------------Size------------------------•-------Liquid depth-------------------------Capacity--•---------------•---- is ield: 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--------.--_------ -.-Total -Total length-----------------------------------••/--- Seepa a Pi#: Distance to nearest/well-A-d------__._-Distant r m fo ndation---��..._--.Distance to nearest lot line_/_5_---.- V 10 Number of pits---.--/----------- - material- 0-� ---Size: Diameter---- 8..._----_-Depth___, , --------------------- G Cesspool: Distance from nearest well-----------------Distance from foundation------------------- material-._---.----------__--------_.__-----_. l ❑ 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 heT, faf tify that I haveyregul ' application an t the work will be done in accordance with San Joaquin County ordinanclaws, andrules ons of the San oauin Local alth s it (Signed} if . . . ------ . -- caner and/or Contractor) ---- ----- - - ---------------------•--------------- Tie - - tl --------------------------- (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----------I---'-R O - ---------------------------•----------- ------ DATE---- - r�.3 �_�_ ------------------- - REVIEWEDBY---------------------------------------------------------------------------------------------------------------------------- DATE--------------------------------.--------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------ ----------------------------- DATE------------------------------------------------------------- Alterations and/or recommendations:-------------------- - --------------•-----------•--------------------•-••------------------------•---•--•---------------------------- 1 T" D{f -- - -------•-----------------------------------•------•------------ -------------------- -------------- ------------------DE_P.rtat �� --------- X5'-'r----- r�c' t -----. '--------------------------..._..------------------ ------------------ ----------- ---------------------------------------------------------------------•------------ ------------- ---------------------------------------- - ---------------------- -- -------- - FINAL INSRECTION BY:- ---- --- Date---------7 ---------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Ici 1,California Manteca,California Tracy,California ce.9 REv16 EO e•59 i.P.G O.ZM 6.60