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Ivr< vrrI",C U0L: ---- --------------- ---------------------- --------------------//-------------- APPLICATION FOR SANITATION PERMIT Permit No. ---------------------------- ---------- (Complete in Duplicate) 'Y,' ---- --- This Permit Ex ires 1 Year From Date Issued Date issued ./--� sf� 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 AND LOCATION.- - -- � ��•�' � `ir�E�� /��— •} Owner 's Name Phone -- - -------- ------ - - ----------------------------------------------- Address------- — Contractor's Name--------------- r Phone Installation will serve: Residence 9?�Apartment House ❑ Commercial ❑ Trailer Court ❑ Mote! ❑ Other ❑ Number of living units: -_/- Number of bedrooms ! -- Number of baths -Z-_ Lot size _ / ------------------ -------------- Water Supply: Public system ❑ Communitysystem y stem ❑ Private Depth to Water Table Character of soil to a depth of 3 feet: Sand 0 Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan E❑ Previous Application Made: (If yes,date---------- --------) No New Construction: Yes ❑ No JR'FHA/VA: Yes [P-`"'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic T Distance from nearest well-- -------------Distance from foundation_.------_------___.Material_..-__-_...--__--.--_-.-.---_________-- � L� No, of compartments----- -------- --------Size--------------------------------Liquid depth----- ---- ------------Capacity- -------- --------- Disposal Fi Distance from nearest well----------------Distance from foundation------------- e --_---.Distance to nearest lot line----------------- i 4� /✓hef Number of lines-------------- --------------------Length of eachline----------------------------- Width of trench. 0 Type of filter material-------------------------Depth of filter material----.-_-._--.---------Total length----------------- 0 / �a r Q S�}eepage Pit: Distance to nearest}ell-- _-.A -------Distance f om foundation----d_�_--_-_Dis s�e to nearest lot lirye_ r-- -- oc [�}� Number of pit's.--.-;C -----------Lining materia!-,/ -: Size: Diameter3 _:._--__-Depth Cesspool- Distance from nearest well------_-_-------Distance from foundation------------------- Lining material---------- ---- ----------------- Size: Diameter------------- -----------------------Depth---------------------------------------------------Liquid Capacity..... -------------------gals. r Privy: Distance from nearest well----------------------------------------- -------Distance from nearest buildin ❑ Distance to nearest lot line-------- ------ --- -- g Remodeling and/or repairing (describe)------------ - -- V --- ----- ----- - --- -- -- - - - -- ------------ --- ------ ------ - --- --- -- -- - - -- - I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County, ordinances, State laws, andel rules and regulations of the San Joaquin Local Health District. (Signed)------------------------ �-�--- .�v_ --- ----- (9r Contractor) --- -- ------- ---- --------- --- ------------- ------------- r By:---------------------------------------------------------------------------- -- Title ----- (Title) ---- . -- (Plot plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------- DA7E.---____---. _ --- --------------------------------------------------------------- ,� -�---------- REVIEWED BY------- ----------------------------------- - - - -- ------- ------------------------------------------- -----------------�------ ------------------------------ ---------------'--------------------- DATE- ---- - - BUILDING PERMIT ISSUED-------- -------------- ------ ------- -- -- DANE---- - Alterations and/or recommendations: /�� --- G ----------•--- ---•-----•------------------------------ ----------------- ----- ----•--------- ------ --- FINAL INSPECTION BY:.... - -- ��- --------------- - Date------------ ---------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca, California Tracy, California F.P.CO.