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FOR OFFICE USE: -3--��:- -------- APPLICATION FOR_ SANITATION PERMIT Permif No. .. .:--=-- - (Complete in Duplicate) Date Issued 1------------------------------------------ ----------- This Permit Expires 1 Year From Date Issue._ 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. e *a i "-` ---'� ----- JOB ADDRESS AND LOCATION 1 Owner's Name- ----------------- ---- --------------- ----- ----------- ------- aarr ------ --------_Phone------------------------------------ Address---------- ---•-------------------------------Address---------- -------- ilfr-.4-1--------------------------------------------- Contractor's Name ------- �` . Phone--------------- ------------------- --. p Installation will serve: Residence -r'Apartment House [I Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: —11---- Number of bedrooms --3-- Number of baths _.A+,. Lot size ---____'f__x--�� ---------------------•-------- Water Supply: Public system ❑ Community system �rivate E] Depth to Water Table __ f+• Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Z'--Hardpan ❑ Previous Application Made: (ifyes,date- ------.----------) No M--Igew Construction: Yes [�Na ❑ FHA/VA: Yes ❑ No ti 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--/.-!L._._...--._.Mate Tal--__►�ea",i7v% `' ------ ®`'"� No. of compartmenfis__._ ----------------Size...._ -- t "� Liquid depth-- --------- Disposal Field: Distance from nearest well._--._.__.._Qistance from foundation__14__----___.-.Distance to nearest lot line__ �-____. s�' f --------Width of trench.--4--f- L�" Number of {fines-_____.�°._�______________________-Length of each line__'�f.�_.-__-_- ' Total len th � b ----------------- Type of filter material___.-f?o ,-,k---_Depth of filter material___/.r------------- g f 5eepa e-Pi+: Distance to nearest well ----------_Distance from foundation__-. _a.____.___.Distance to nearest lot iine__�_____.._ Number of pits.----�k-:----------Lining mate ria l__-4>L.+,Size: Diameter---------..3.3-"Depth--- 'IZ Cesspool: D•stance from nearest well-----------------Distance from foundation.----.--------------Lining material__.-----_-__----_----__.__-_---___--. ❑ Size: Diameter___________________ __ -------- ----Depth----------------------------------------------------Liquid Capacity----- --------------------gals. i Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------ ----- ❑ ---------------------------------------------------------- Distance to nearest lot line - ----- ----------- ---------- -------------------------------------------- -- Remodeling and/or repairing (describe)-------------------- ----------------------------- ----------------- - ----------------------------------------------------------- ---- ----------- --------------------------------------------- ------------------•------------------------------•-------------------------------------------- -------------------------------------- ------------ ---- h I hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin Coun ordinances, State laws, and es�and regulatibnsfof the an Joaquin Local Health District. ------_--------------------(Owner and/or Contractor) (Signed) ------------ ----------------------------(Owner _ 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_---- --------------- - -------------- - ----------------------- DATE------ -------------------- -- ---------------- ! REVIEWED BY------------------------------- ------ DATE------------------------------------------------------------ i -------------------- DATE------------------------- ----- -- BUILDING PERMIT ISSUED-------------- ----- ----- - - -------------- Alterations and/or recommendations:------ -------- ------------ --------------•---•--•------- ---•----------------- ------------------------ ---------------------------------------------------------------------- -- -------------------------------------------------------------------------------------- ----------- -- - 3� -- � FINAL INSPECTION BY--------------------y..-------- - ---- ------- ----------- Date------- - ------ ---- SAN JOAQUIN LO HEALTH DISTRICT 1641 E.Hazelton Ave. 300 West Oak Street 124 Sycamore street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.G O.