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FOR OFFICE USE: --- - -- --- ---- �a------ 2 d �_ ------------------------------------._________________ APPLICATION FOR`'SANITATION PERMIT Permit No. ...... -------------------------------------------------------- (Complete in Duplicate) Date Issuedll-/� ------------------------------------------ ---------- 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 described. This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AND L CATION `r = / ! %G -- Owner's Name. - ----------------_--- ---------------------- 3- Address ----------------- f_ :' - Phone J , r Address_ -•- -• • ---•-•••----- --•-••••-••---• - -- Contractor's Name-- '-•-- jr = �c------------------ ---- ---------------------------------------- Phone.......................•---------- Installation will serve: Residence .0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _..----- Number of bedrooms _ ___ Number of baths J_____ Lot size . ----_'------ '— f- Water Supply: Public system ❑ Community system ❑ Private, ] Depth to Water Table 6..6'_ ft.- Character of soil to a dep of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made:z. (If yes,date----------------.---) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION ,4ND 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 depth--------------------------Capacity------------•-------•-- Disposal Field: Distance from nearest well.-�d__ {-Dist nce from foundation_.-/_!?-----------Distance to nearest lot line__ ....... p /l Number of lines------ -_._ Length of each --------Width of trench-----.�_�_ -----__._____.__ Type of filter material,= '��_.--__-_-__Depth of,` ilter material----/�---- g Total len th--�-11�-------------------------- Seepage Pi�: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line._--_-_--_--_____ Number of pits----------------------Lining material----a------- -•_ ..-Size: Diameter-----------------------Depth_.-_._...__..___._____._-___._ Cesspool: Distance from nearest well-----------------Distance frot#foundation--------------------Lining material_-_.._-___-------------______--__. ❑ Size: Diameter----------------- ------Depth------------ -------------------------------------Liquid Capacity---------------------•------gals. k Privy: Distance from nearest well_______________________________________ Distance from nearest building------------------------------------------ ❑ Distance to nearest lot line--------- -------------------------- -----=------=•----•-----•-------------------------•----------- ---•- --------------------- Remodeling ----------------- Remodeling and/or repairing (describe) .< :_ --------------------- -------------------- -•-- - ---- ----- ---------------------- ------------•-----------------------------•-------------------•----------------------------------------------------------------------------------------------- --------------------------------- -------- ------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- -------------- 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 Wes and regulations of t San Joaquin Local Health District. (Signed) - ;r .?a..L. (Owner and/or Contractor) By:----------- . _- ------ --(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 p APPLICATION ACCEPTED BY_-r- -----_ - _ DATE < �f ------- REVIEWEDBY------------------------- ---------------------------------_------------ --------------------------_---------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED--------------------------------------------------------------------------------------------------- -- DATE------------------------------------------------------------- Alterations and/or recommendat' , _• - - -------. ---------------------•-------------------- ----------------•. ...... ----- _/---------------------------------------------------------------------------------- INSPECTIONBY:............------------------------------------------------- Date--- ------- ------------------------------ ------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C C.