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FOR OFFICE USE: ----------------- - ---------- ----------------------- l� . APPLICATION FOR SANITATION PERMIT Permit No. ... ... ...... ------------------------- -- ----------- ------ (Complete in Duplicate) Date issued --------------------- -------------------------- This Permit Expires it Year From Date Issued Application is hereby made to the San Joaquin Local Healfh District for a permit to construct and install the work herein described. This applicati rt 's a in c pliance y h uniy Ordinance No. 549. B A� 'A D L� N. 1 ' YI-/7-/ --- - s asap --- '� JO f Owner's Name--rte' --,-;------ Phone-.---------------------------------- Address------ ----•------------••------------Address------ 1-1111-----9n. If-III • -- ...------I---------•----------------------------------------------------------------------------- -: - Contractor's Name6__ ---- - -- -- i -----. Phone--------------------------------- Installation will serve: Residence d / rtment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __1----- Number of bedrooms -Z-.. Number of baths -_ __ Lot size ---r _ ^ ------------------------------ Water Supply: Public system ❑ Community system ❑ Private'o Depth to Water Table 1-00- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel p Sandy Loam,Z Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: 11f 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 Septic Tank: Distance from nearest well_ -a -..---Distance from foundation--- 0..---_-_--.Material-- �tfh!�4��1G_1.,----------- ® � ��}---`r------Liquid depth-------4- ------------Capacity___1_;' _0--------- No. of compartments-.-.--�---------------Size-_�-�----____-- Disposal Field: Distance from nearest well.-�,O---.-___-Distance from foundation� .............Distance to nearest lot line--S--------:-.- Number of lines---.3---------------------------Length of each line-------!-4.................Width of trench-_- 74---.--------------------- Type of filter material--i -- ---------------Depth of filter material---A-R._' -----------Total length---�_tf_9'---------------------------- Seepage Pit: Distance #o nearest well------- from foundation_-----_._----.---.Distance to nearest lot-line--.-------------- ❑ Number of pits----------------------Lining material---------- -----------.Size: Diameter. ---� Depth -- . _ __*--f Cesspool: Distance from nearest well-------------I_--Distance from founclafagp----------------__-"Lining material----------------------------- ❑ Size: Diameter----------------- ----------------y -Depth-------------------------- ---------- ---------- Liquid Capacity gals. Privy: Distance from nearest well--------------' ---.......,-D_ikt.ar e from nearest building------------------------------------------ ❑ . , Distance to nearest;]of ane--------" ��---------- ---••------ ------------------------------------------- ---------------- -------------- ----------------------- Remodeling and/or repairing (describe}:__."---------------- t ------------------------- ------------------------------------------- -°------ ---- { 1��. '� ---- __�__•lP--•------------" --------------------------- ------------------------------------------- I hereby certify that I have preparedsfhis application and tha+*the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the-San Joaquin,Local'He lih District. (Signed)_ l� �` --------------- ------(Owner a---n-d---/--o-r Contractor) - ------------------------------- -------- - -- (Plot plan, showing size of lot, location of system to relation wells, buildin s; etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i APPLICATION ACCEPTED ''---------------------- ----------------------------------------- DATE-------`2-- ----7------------------------------- - REVIEWED BY-------------------------------------- - -" ----- DATE----------------------------------------------------------- - - --------------------------------------------------------------------- - BUILDINGPERMIT ISSUED------------------------ --------------- DATE-------------------------- --- -------------- ----------- Alterations and/or recommendations:--------------------- ------------------------------------------------------------------------------------- r -----'•------------------`-------------------------------------------- ----------------------------------------------'-----------_....--------------------...___-----.---------------- --------------------------------------------------- -, - - - ------ --------------------- --------- FINAL INSPECTION BY:-�------ ----- ------°� --------------- Date ------ ---- ------- - SAN JOAQUIN LOCAL HEALTH DISTRICT; 1601 E.Haielton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California � ! 1