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F R OFFICE USE: ,. Y --- ----------- o APPLICATION FOR SANITATION PERMIT Permit No. ..... �...__ S (Complete in Duplicate) Date Issued ----- -- - - ----_ ------ This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein descried. This application is made in compliance with County Ordinanc No. 549. JOB ADDRESS AND LOCATION---- ---------------------------. ---"" ------- -- Owner's Name.------- ------ -------------- -------------------------------------- d— ---------------- Phone --------------- Address------------ f ------------------------------------------------------- ----------------------------------------------------- 23 ---. Phone.'-=------------•---------- Contractor's Name-------------------- - --- -- ---------•---------------- -----------------=-----------•---- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel f❑ Other B-11, Installation -- Number of baths -`---- Lot size _- .--. C.-. .�---------------------- Number of living units: s�-- Number of bedrooms _� +� i Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date-----------,--------1 No New Construction: Yes ❑ No gj' FHA/VA: Yes ❑ No ®— TYPE OF INSTALLATION AND SPECIFICATIONS: f. - (No septic tank or cesspool permitted if public sewer is available within 200 feet.) SSeeppti�c.T Distance from nearest well----- ------------Distance from foundation-------------------Material--------------------------------------- --------- No. of compartments------ - Size--------------------------------Liquid depth Capacity Disposa9V Feld; Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line---------- ------ Number of lines------------------------------------Length of each line----------------------------Width of trench.------ ------ •------------------ Type of filter material-------------=- --------Depth of filter material----------------------- otal lengfh------------------------------------------ e Pit: Distance to nearest well--_--1�--`----------Distance f om f undation--A4____..-- Dist�afnce to nearest lot ane------------ ---- IV --- Number of its-_-.-- -_ Linin material- -.--Size: Diameter.•3�-------------Deptha.�� ---- C knI pi ------ 9 G Distance from foundation--------------------Lining material------------------------------------- Cesspool: Distance from nearest well---- ❑ Size: Diameter-------------------------- ----------Depth-------------------------- ------- ------- ------- Liquid Capacity :5als. hh Privy: Distance from nearest well---------------------------------------- --------Distance from nearest building-------------------------------------- l ❑ ----------------------------------- Distance to nearest lot line ----------- � ------------------------- Remodeling and/or rep . . g Ide ri1 G r ---s - t -------------- -- - -- ; V G---------------- 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. Si ned ------------- r Contractor) -------- ----- --- -- -;'. ---- ---- ----- -- -- ----------- -----(Title) •' --- - -------- (Plot plan, showing size of lot, location of system elati on to wells, buildings, etc., can be laced on reverse side). FOR DEPARTMENT UAE 9NY APPLICATION ACCEPTED BY------------------------------------------------------------ -- ---- --- -- ----------- DATE ' - REVIEWED BY-.--.- --------------------------------- -- ------ DATE -----------------=--- ----------- -t - BUILDINGPERMIT ISSUED---------------------------------- -- -------------------- ---------------- DATE--------- ---------- ---------= --------------- Alterations and/or recommendations:--------------------'7'- ----------------------------------------- Alterations and/or ►Z------------------- ------- -------------------------- FINAL INSPECTION BY:----- ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California