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FOR OFFICE USE: 1 7w J7 Permit No. .. C,..�a - ------------ ---------- ---------- -- --- -- --- -- --- APPLICATION FOR SANITATION PERMIT ------------------- - ----------- (Complete in Duplicate) Da#e Issued ---- - 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 compliancejwith County Ordinance No. 549. �.�y �._ ------------------------------••---------- - JOB ADDRESS AND LOCATION--------• -'t'----- --- --------- f`� �,c�...,v ------------------ ---- ---------- Phone-- Owner's Name.------------- /� Address ,7G` � ------------ Contractor's Name------- - 4� 4 �-_.---• - ------ -- -- ------------------- Installation will serve: Residence � Apartment House ❑ Commercial E] Trailer Court ElM�oy#el ❑ Other ❑ Number of living units: __,� Number of bedrooms -./-- Number of baths __/__ 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 F1Sandy Loam [:1Clay Loam El Clay Hardpan Clay ❑ [I Previous Application Made: (If yes,date._ --------) No ' New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No El E s TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) i Septic Tank: Distance from nearest well•-----_----------D'sstance from foundation--------------------Material _-____..____._____._.__...______.__._..___._.-. t ❑' No. of compartments---------- -----------. Size--------------------------------Liquid depth Capacity ( , tline Disposal Field: Distance from nearest well- ---------------Distance from in to nearest lot line-------_---_-._-. ❑ Number of lines-- --------------------------------Length of each line----------------------------..Width of trench------------------------------------ Type of filter material-------------------------Depth of filter material----------------------Total length---.---- - L G 1/a__'0____.Distance to nearest lot line--IT------ Seepage Pit: Distance #o nearest w/ell-_ ____..__._._Distance fr f undation__ Number of pits-- rr------------Lining material-----7�__-Size: Diameter-------------- -- ---Depth----- 5---_----------- -• Cesspool: Distance from nearest well-----------------Distance from foundation...........-........Lining material-----------------------------------als. ❑ Size: Diameter.- #------------ ------------- ------Depth_--------------------------------- Liquid Capacity 9 (IDistance from nearest building Privy: Distance from nearest well --------------------------------------- ------- ------------------------ - ❑ tt, ---------------------- Distance,to nearest lot line- - ----------------------------------------- -------------------- ------------------------- Remodeling and/or repairing (describe)--------------------------------------- -- -------------------------- ----------- I ------------------------- - ----------------- --------------- f ____________________"-__.-_._.______-____._______ -______._..____.__________ --------------------------------- 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, and rules and regulations of the San Joaquin Local Health District. (Signed) ___.-_-(Owner and/or Contractor) -----_- ---------- I - ----_--- ------------------------- -------(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 J APPLICATION ACCEPTED BY --------------- DATE - 0- - ---------------------------------------------- REVIEWED BY-------------------- ----------- -------------------------- --------------------------BUILDING PERMIT ISSUED--------------i------------------- ------- -- --�-------------- - Alterations and/or recommendations:.__(---------------------------------------------------------------------- ----------------- --------------- -------------------=------ ----- ---------------•- ------ �I --------------------- -- - ---------------------------------- - - - ----------------------- -- 4 FINAL INSPECTION BY:.. .-- --- ---- Date-------- ------------ � -------- ---------------- ,a { 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 a S � v _