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FOR OFFICE USE: -.6_S-1 ................. ----- ------------- -------------------------------------- ---�- 3--4-- . APPLICATION FOR SANITATION PERMIT Permit No. -ff�. �� --------------------------------------•- ------ (Complete-in Duplicate) ----------------- This Permit Expires 1 Year From Date Issued 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 application is made in compliance //with Q�County Ordinance No. 54 . JOB ADDRESS AND CATION � ----- ---t ------- -- Owner's Name ------ ---------------- -- ----------------------- ----- --------------------- --- Address.................. -Address-------------•---- - -----•• ---- - --- - -- Contractor's Name - r ------------ -------------------------- Installation -----------------------Installation will serve: Residence IN Apartment House ❑ Commercial ❑ Trailer Court E] Motel ❑ Other Number of living units: -/-_._ Number of bedrooms =2-_ Number of baths-_/_ Lot size ----0�` - -------------------- Water Supply: Public system ❑ Community system ❑ Privatex Depth to Water Table 8.!P- ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date................... ) No ❑ New Construction: Yes ❑ Nox FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) •S is Tank: Distance from nearest w61_..............Distance from foundation--------------------Material ....-.---_----.--.-.___-------_____-----_---. No. of compartments--------- ......... ....Size-------------------- -----------Liquid depth--- ----- ------ ------- Capacity----------------------- is ,Meld: Distance from nearest well- - - ------Distance from foundation--------------------Distance to nearest lot line----------------- Number of lines ----------------------------------Length of each line-- ---------------------------Width of trench,-,-------------------------------- Type of filter material---_-___..........-_t Depth of filter material_---------------------Total length-___-.-------- .--------- r Seepa Pit: Distance to nearest well ...--------Distance r fo ndation_-'- .--- Distance to nearest lot lines-� 1sc�� Number of pits___--J-------------Lining materia��f ize: Diameter___--._.....__.Depfh-__-�-5----_----------- esspool: Distance from nearest well --------- .--Distance from foundation................. ..Lining material---_----------------------_---------- ❑ Size: Diameter- -- --------- - --- ----------------Depth------------------------------ ---- ----------------Liqutd Capacity------- --------------------gals. Privy: Distance from nearest well----_______-_-------------------------_.--_____Distance from nearest building------------------------------------------ 171 r Distance to nearest lot line ------- -------------- ---- -------------------------------•----------------------- ---------------------- ---------- - ---------- 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, tate laws, and rules Zd regulations of the San Joaquin Local Health District. r r r (Signed) - ----------- --- - ----- ----- -- r and/or Contract wne d/o or] By------------------•------•--------------------jl)� ` - ----- {Ti+le] (Plot plan, showing size of lot, location of system in relation o wells, buildings, etc., can be placed on reverse side). Fq&qEENT USE ONLY f APPLICATION ACCEPTED B �-- - ------------ - -------------- DATE-------- ?-- ~ REVIEWED BY------------------------ ------------ DATE ------------------------ BUILDING PERMIT ISSUED -------- - - ---------------------- - ------------------------------------- DATE------------------------ --------------------- Alterations and/or recommendations:---------------------------- FINAL INSPECTION BY:...77k--¢l d �� Y� Date..---- 7...-�/.�--�.--� - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockton,California Lodi. California Manteca, California Tracy,California E.H.9 2M 1-67 Vanguard Press