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FOR OFFICE USE: ----- ---•3 Permit No. ---•-_---------------- APPLICATION FOR SANITATION PERMIT --- ..tee-- -- ��-�y-1�'----- �- ------ (Complete in Duplicate) d ----------••----------- This Permit Expires 1 Year From Date Issued Rate Issue ----------------------------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install themork herein descried. This application is made in compliance with County Ordinance No. 549. - JOB ADDRESS OCATI ---- --- ••--•-- Owner's Name •----•--•----- •-----•-•-------------•-•----•--------------- ----------- - Address. •-•....... ...... .. ------------------ r - -•--- - Phone: l Contractor's Name-----•-•----------•-•-----------------•-- Installation will serve: Residence partment House ❑ Commercial I] Trailer Court E3Motel ❑ Other ❑ Number of living units: . _ Number of bedrooms g;-7-- Number of baths --/'Lot size _... Water Supply: Public system [] Community system ❑ Private Depth to Water Table 6_Q ft. soil to a depth of 3 fee+! Sand ❑ Gravel El San d loam E) Clay Loam [I Clay ❑Adobe ardpan ❑ Character of P I — �. _ Previous Application Made: (If yes,date--------------------) No New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No E] TYPE OF INSTALLATION AND SPECIFICATIONS: Distance from foundation____-____--____-- .Material_____"._____. *(No septic tank or cesspool permitted if public sewer is available within 2110 feet.I Distance from nearest well____-_______-_ _ -...........•.................... No. of compartments. ------------------------Size--------------------------------Liquid depth----------------- --------Capacity...................... � Disposal Field: Distance from nearest well_x��-----Distance from foundation.�L?_...---Distance to nearest lot line as¢... c +� Number of lines...._ ___.._ Le th of each line____.-�----------o-Width of +rench__�_c ��.__ Type of filter materiaLt_�tb of filter material____.__y� __.__.Total length______________________ Seepage Pit: Distance.to nearest well-----------------------Distance from.foundation---------------.._'.Distance to nearest lot line_---_____--•_-_ ❑ Number of pits-- }------------------Lining material.-------------••-----..Size: Diameter------------------------Dept -------•--------•-•.......•------ i from foundation____________________Lining material------------------------------------- Cesspool: Distance from nearest well_____-_•___....._Distance ❑ Size: Diameter._.. --------------------------Depth_+__.-----------'••••---------------------------Liquid Capacity._------------- ......961S. _._-_-_-___Distance from nearest building Privy: Distance from nearest well --------•------- -------------------- 9----------------------•------------------ ----------------------------------- -•------••---•--•� , ❑ Distance to nearest lot line------------------ �� !; ---- Re'-modeling and/or repairing (describe)___________ ________________________ _ -----------__------- --•----------- •----•.................---------•••-----••-...•---••••-------••--....---- _ __ i t I -•------•-----•-----_-------•--- I hereby c®rtif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, t I s, and ruI s and reg ions of the San Joaquin Local Health District. • • --------------------------•--�- Contractor] ___. __ ._ _ wrier and/or ontrac or) ------ (Signed) a ------ -- _ (Plot plan, showing size of lot, Iota#ion of system in rel ion +o"wells, buildings, etc., can be place on reverse side}. i FOR DEPARTMENT USE ONLY r ( APPLICATION ACCEPTED BY REVIEWED BY------------------------------•-•• --------- - ----•------------------- ------------------------------ DATE-----------•-- -----------------------------------:-------- BUILDING PERMIT ISSUED DATE i Alterations and/or recommendations:..------------ ------------------------------------------ -------------------------------------------------------------------------t............. ------- -..-------------•-------------•------------------------•-•-•----------_-----,_._.....-----............. ------------------------------------------------------------------------------------------ --•---------•----..-.----•--•--------•---•----_---•-•--------•------------------•-•--- ------------ ----------------------••---- - • --------- -� ---- --• Date----- �--��- -------------------------- --------------------- FINAL INSPECTION BY:..---- --- ---- - -- -- - SAN JOAQUIN LOCAL HEALTH DISTRICT I 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 REVISED 6.59 ENA 5-61 ATLAS 4