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FUR OFFICE USE: --------------------------------------------------------- APPLICATION . FOR SANITATION PERMIT . Permit No. _-••------........__-- ------------------------------------- ------------ ----- (Cornplete in Duplicate) --------------- This permit Ex fres 1 Year From Date Issued Date Issued __-...__------ .r Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work h ein&er, ibed. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN LOCATION_ Pho qt47 , Owner's Name_____ °' - -------- - ----- - ------------------------------------ Owner's - --- -- --------------------- Address -------------- a � O --- ------------------------ Contractor's Name-- - ------- ------ -- --- --- --- - --- ---- --Gt_ ._.. Phone.... Installation will serve: Residence ❑ Apartment ouse ❑ Commercial ❑ Trailer Court ❑ Motel Other ❑ Number of living units: Number of bedrooms 1_4 Number of baths _��___ Lot size Water Supply: Public system ❑ Community system ❑ Private [?�Dpth to Water Table _7.0 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑• Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date------ ----,--------) No ❑. New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ 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--------------------Material__-_-_________-____________-.__________________- ' ❑ No. of compartments-----------------------_-Size------------------------- -----Liquid def.th--------------------------Capacity----------------------- Dis field: Distance from nearest well------->�G_._Distance from foundation___._JQ---_----Distance to nearest lotsine-----S-/._- . Number of lines_______________�_-__ ---- _Length of each line________-1M_--_� _---_-----Width of trench._____- .__________________ j_ ��De th of filter material-- - ' _�r g Q O f Type of filter material__-t61 i p -� -- ---------Total length ` Seepage Pit: Distance to nearest well----------------------Distance from foundation--- ----------Distance to nearest lot line______________._ �+ ❑ {Number of pits----------------------.Lining materia€-----------------------Size: Diameter------------------ ----Depth------------- ------------------ Cesspool: Distance from nearest well----------------- from foundation__------------------Lining material ____-----------___-_._ ❑ Size: Diameter ----------- ---Depth------ --------------------------------------------Liquid Capacity----------------------------gals.f Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------------------------- ❑ Distance to nearest lot line------------------------ Cl Remodeling and/or repairing (describe):--------- ------------------------------------------ ---------------------•-- •-------------------------• ------------------•-------------1-----'-'-'--'---------------- --------------------------------------------------------- ---------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and +hat +he work will be done in accordance with San Joaquin County ordinances, State laws, a r s and regulations of the San Joaquin Local Health District. s (Signed) c =---- --- - -- -------------------------------------------------------•------------- �/or Contractor) By. -----° --- - - ------------------------------------(Title)------------------•------- - ,-- (Plot plan, showing size of lot, loca+ion of syste . in relation o wells, buildings, a+c., can be placed on reverse side}. .a FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------------------------ ----------------------------------------------------------------- DATE.------ ----: ----- REVIEWEDBY----------------------------------------- ----------------------------------------- ------------------------------------------ DATE BUILDING PERMIT ISSUED------------------- ----------------- I-------------------------- - DATE Alterations and/or recornmendaf ions:------ -----.---- --------------------- ------- ------------------------------ - - .-------•------------------------------------------------------------•--- -------------r ------------=-- -------------------------------------------------- -----•------------------------ --------------- --------•---•- --------------------------------------------------- FINAL INSPECTION BY:..---------- = Date - - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Mazolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California f ES 9 REVISES 8.59 3M 3-'63 F.P.CO. n