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FOR OFFICE USE: ------------ ----_---- ---------------------- - ------------ -----------------_-______- APPLICATION EOR. ;SANITATION PERMIT Permit No. - (Complete, ira Duplica+e) This Permit Ex�ires ]`Year From Date Issued T 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 Scomplian�ce with County Ordinance No. 549. . �-.�•-[:-.� ,v7-� - � leo �[�• JOB ADDRESS AN LOCATION_ -_c - Owner's Name --( `r - T - ----- Phone------- Address ----------- _�_ t.. . -------------------•-----------•--------------------- ----- --- Contractor's Name----- --------------- ------------------------------ ----------------- -------------- Phone `. Installation will serve: Residence Apartment House [❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other Number of living units: __�----- Number of bedrooms __ __ Number-Of baths -_ ff 1_ Lot sizes ❑ _ -------------------------------------- ' Water Supply: Public system d Community system El PrivateDepth to Water Table . ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan P �+ 1 r ❑ Previous Application Made: (If yes,date-------- ) No `� ^ New Construction: Ye`s 6 No ❑ FHA/VA: Yes ❑ No�j� v ' TYPE OF INSTALLATION AND SPECIFICATIONS: \\ .,__�(No septic +ank or cesspool permitted if,public se�wer_is available within 200 feet.) _ O -•r -- �= - Sep is Tank: Distance from nearest well _ -----------Distan e, from {ound on__ �� _._ -.Maj rial_� "C,(� +_- -- No, of compartments--. Size ` _�x 1a pth_ ' q _____Ca acit 'j_g Dispsal Field: Distance from nearest well.__[ ----Distance from foundation___________________Distance to nearest lod__..-- Number of lines---� )__ � � --------"-__ - Length of each line7j_"7,. �---Wi�}th of trench---._.Type of filter material J __ -_ ___._ _Depth of filter material___- c _--____Total length____________Seepage Pit: Distance to nearest well______________________Distance from foundation_--_._____-__`___-Distance to nearest lo __________❑ Number of pits- ----------- -------Lining material------------ ---- -Size: Diameter------------------- Depth ------ Cesspool• Distance from nearest wall______________-_Distance from foundation_---_-__ _-__--- --.Lining material__"_______-- --"_----"❑ Size: Qiameter-_ Depth ----- ---- ------ ----- ---- --------Liquid Capacity ------ gals.�. _ .. . . .rom nearest well__.- -.__ r' -��- ��-�"Distance from nearest building ------------❑ Distance to nearest lot line--------------------------------- ------------ --- Remodeling and/or repairing (describe):_____"_____________ ---------------------------------------------------------------------------------------------•-------------------_---------------•-----------------------•--------------------------- ---------------------------------- �, - ----------------------- - I herebycertify that I have - Y 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 � , ( g )---- ~ Ifs---OQ - _( P By:___- _ ---•-------•--._.-----__ ------------------- --------•--------------=----_ -------•=-----(Title) caner and/or Contract d/o or) Plot Ian, showing size of lot, location of system in relation to wells, buildings, e+c.,'can be placed on reverse side). * � F FOR DEPARTMENT USE O ' N LY APPLICATION ACCEPTED BY_"_____ - HATE________ ---- -------------- --� REVIEWED BY------------------------ -------------- -------- ------ ------------ ------------ --------------------- - - -. _._ DATE__ .. BUILDING PERMIT ISSUED_ ------------------------- ------- -- ------ DATE-------- - -------------------- -- - - Altera+ions and/or recommendations:______--__- ---. ---------------------- ------------------------------------------------ -- ---- - --------------------- ----------•------- - --- -------------------- -------- FINAL -------FINAL INSPECTION '- �/ De--�-- ------------- t ----- -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazolton Ave. 300 West Oak Street 124 Sycamore Street1 205 West 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVISED B-59 3M 3-'63 F.P.Eq.