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FOR OFFICE USE: ------------------ ----------- ----------------------------------- - - --.--_ APPLICATION FOR SANITATION PERMIT Permit No. - (Complete in Duplicate) ------------ ---------- -- --------- -- Expires This Permit Ex ires 1 Year From Date Issued /�9 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 wiCounty Ordinance No. 549. --= ------- Owner's r'DNameS AND LOCATION t � -r- -at& ?Pi� - 4 ------ Phone--- eaz Address---a ..�.* -. s1 f s� Contractor's Name --------------., Phone.y��- -------- Installation will serve: Residence Q Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---f--. Number of bedrooms -- Number of baths -__,l_ Lot size __-f_ Water Supply: Public system ❑ Community system ❑ Private �epth to Wafer Table _ c�ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [�J `lay Loam ❑ Clay [:1 Adobe ❑ Hardpan [] Previous Application Made: (If yes,date....................) No ❑ New Construction: Yes ❑ No R4�- FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.). 6 ' Tarek: Distance from nearest well_________________Distance from foundation--------------------Material___------------------------------------ No. of compartments---- ----- ---------------Size--------------------------------Liquid depth---------- --------------Capacity-------- Disposal Feld: Distance from nearest well.- Q_ Distance f`om�founclation_..5�,.�..___-Distance to nearest lot IineF -� Number of lines------/-----_ ___ __________Length of each line_-_1_ZZV- - --- ---------------Width of french.--__.v�----- , Type of filter mafierial_ c_ '.--Depth of filter material_----/_9.____-_.Total length----------------------ld _....._ j 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------.__._.-______-_-.___-_____ I t Size: Diameter-------------------------- -----------Depth----------c --------------------- Liquid Capacity----------------------------gals. C. Privy: Distance from nearest well------_------------_------------------ ----------Distance from nearest building--- _.-__-._-____-_---.__--,- ❑ Distance to nearest lot line. k ------------------------------------------------------------------- Remodeling and/or repairing (describe):--------------------- I -------------------•-----------------------------------------------------------------------------------------------= ---------------------------------------------------------------------------------------------------------------------------•------------------------ ----------------------------------------------=------------------------ ----------------------------------------------------------------------I------------------------- ----------------------------------------------------------------------------------------------------------- --- - ------- I hereby certify that I have prepared this application and that the work will.be done in accordance with San Joaquin County ordinances, to laws, oind rules nd r gula#ions of th San..Joaquin Local,Health District. (Signed) ------- ?ced -- caner and/or Contractor} , Plot Ian, showing size of lot location of system in relati to wells, buildings, etc., can 69 pl---------- ------- - _{ p g � preverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDREVBY DATE ---------------------- IEWED BY--------------------------------- --------- - -- ---------- DATE------------- ------------- - ------------------------------------------------------------------- --------------------------- UILDING PERMIT ISSUED---------------------------------------------------------------------------------------------------- - DATE Alterations and/or recommendations:----------------------------.----------- ------------------- .. 1 ----------------------•---- ---------------------------- ------------------------------------------------------ -- ---------- --------------------- ----------------- - FINAL INSPECTION BY . . - - - .--------- Da#e -. ----'. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Na:elton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C Q.