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FOR OFFICE USE J -,fit----- `�/�-��------.-- --- -------- ------- - �3 __________________ APPLICATION FOR SANITATION PERMIT Permit No. (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 described. This application is made in compliance with County Ordinance No. 549. TIf ::------JOB ADDRESS AND O A . � - Phone =- - --- -- -- ----------- -------------------------------------------Owner's Name Address-------_----- ........ - ------------ Contractor's Name--- - -- ---- ----••-- ------ ---•---------------------------------------- Phone Installation will serve: Residence 'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: j----- Number ot-bedrooms Number of baths __ Lot size ------------------- Water Supply: Public system �ommunnity system ElPrivate ElDepth to Water Table ft. Character of soil to a depth of 3 feet: :Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobelardpan ❑ Previous Application Made: (If yes,date--------------------) No 5 - ew Construction: Yes �o ❑ FHA/VA: Yes ❑ -,No'� TYPE OF INSTALLATION AND,SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within.200 feet.) tic Ta * Distance from nearest well-----------------Distance from foundation--------------------Material-----------------------------. .--._----.-_�--•-- -- No. of compartments--------------------------Size--------------------r------------Liuid de th-----_-_----_..-._-------Capacity-------------------- A. sposal � ie'Id1 Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- . / ] Number of lines-----------------------------------Length of each line.-----------------------------Width of french---------------------------.-------•- 1 Type of filter material-------------------------Depth of filter material------------- ---------Total length---------------------------------- ---- - Y► �2._._.___-_.Distance to nearest lot line_-�� - See it: Distance to nearest well_ - ----_-_._Distance from f ndation__- .-.. I;_ ----------- Number of pits--------I------------Lining mate rial__�t6_ _..Size: Diameter.-__, - .�.-...---Depth-------c4+--_�-.------_- Cesspool: Distance from nearest well-----_----__----Distance from foundation--------------------Lining material------------------------------------ ❑ ---Depth----------------- ----------_.Li Liquid Capacity Size: Diameter-------------------------- ------- ---------------------.- q -.-----•--•-••----------••--gals. Privy: Distance from nearest well------------------------------------------------- from nearest building-----__-----_------_--..-----.------...-.. ❑ Distance to nearest lot line- ----------------------------------------------------------•-•-•-----------------------•------••-------------------------------------------- Remodeling and/or repairing (describe)---------------- ------------------------------------------- -------------------------------•-------------._.------------------------------------ -------------------------------------------------------------------------------------------------------------- ._.. ------------------------------------ -----------------------------------------------------------------------------------------------------•-----------------------------------------•--•------------------ I hereby certify that l 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) By:--•----•---------------------- .------ -- -------------------------------------------------------•---------------(Title)---------------------------------------- ---------------- (Plot plan, showing size..of lot, location of sy tem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------- ----- - -------- DATE A Y f L` � ;----------------=-- hV ---------- BY---------------------------------------------- -- - -- "�- - --------------------- --- DATE-•-•- ------------------------------------------ REVIEWED E BUILDINGPERMIT ISSUED-----_------------------- -------------------------------------------------------------•--._ DATE------------------------------------------------------------- Alterationsand/or recommendations----------------------- -----------------------=---------------------------------------------------------------------------------------------••------------ ------------------------------------------------------------------- -•----------------•------------•-- ---------------•------- ------------------------ --- --------------------- - '------ -- ---- -- - - ---=--------------------•--- ------.----7 --------------- -- -- - --..»-------------------------------- --------------.----------------------------------------------------- --------------------------------------------------------•---------.-.------.---- -- ------------------ -----------------------------y - - FINAL INSPECTION BY`�� - 1� L1f.. .-- ------------- Date.-----�::7A� � 5;v- ------ P SAN JOAQUIN LOCAL HEALTH DISTRICT 130 South American Street 300 West Oak Street 124 Sycamore Street 205 West 9th Street ` Stockton,California Lodi,California Manteca,California Tracy,California E9.9 REY19E0 6.59 F.P,C0.9M 6.60 �i