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FOR OFFICE USE: ----------••------------------ -------------------------- ---------- -------------- ---------- ---------------- APPLICATION FOR SANITATION PERMIT Permit No. ...... - -------------- --------- ------------------------•---- (Complete in Duplicate) r ------------ --------- ------------ Date Issued 7/ It'l 7/ This Permit Expires Year From Date Issued f , 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 AOrdinance No. 549. JOB ADDRESS AND LOCATION._-_--.2_6 0 --------------�----- Owner's Name------------- --•----------------- ------ Phone-----_---•------------- ........... a Contractor's Name------ . ..................... Phone................................... - Installation will serve: Residence [&"-Apartment House J❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---V. Number of bedrooms ---/--- Number of baths ------_ Lot size Water Supply: Public system Community system ❑ Private ❑ Depth To Water Table ..S' t. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe,r"Hardpan ❑ Previous Application Made: (If yes,date--------------------) No� �l New Construction: Yes ® o E] FHA/VA: Yes ❑ No ®� TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest weilc-7%_ZrX-< Distance from foundationI4�... --._..Material_-_-J------------------•---__----------_______. No, of compartments ._ ' P �� --Size-_... X�--X 41-.Liquid depth---�-- ---------------Capacity-_?9n .--------Distance [ Number of lines-------I--------------------------Length of each line------W_....__........Width of trench---.------- .f!. Type of filter material-------------------------Depth of filter material-----------------------Total length-------------------... _--------------.-_ Seepage Pit: Distance to nearest well --------------Distance from foundation____________________Distance to nearest lot line---_----.---_-.-. ❑ Number of pits----------------------Lining material-----------------------Size: Diameter--------------- -------Dept h----------•--------. Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material----.-.-----___-----------------•---- F ❑ Size: Diameter--------------------------------------Depth__----------------------------------------------Liquid Capacity........ -------------------gals. Privy: Distance from nearest well-----------------------------------------------Distance from nearest building ❑ Distance to nearest lot line Remodelingand/or repairing (describe)------------------------ ------------------------------------------------------------------------------------------------------------------------- - . r -------•--•--------------------------------•----•---------- ------------ ----••------------------------------••----------------•-------------------•-------------•---------------------------------------------- hereby certify that 1 have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and reg lations o the San Joaquin Local Health District. (Signed)------------------------------------------- ------------- - ----------------(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 APPLICATION ACCEPTED BY----- J DATE - I REVIEWED BY-.. ----------------- - -------------- DATE------ -- ----------------- UILDING PERMIT ISSUED------------------------------• DATE Alterations and/or recommendations------------------------ ` .-•----•-------- FINAL INSPECTION BY:... k__C.(,� - -------------- Date---------- - -•--! - SAN JOAQUIN LOCAL HEALTH DISTRICT �- - -/ 130 South American Street 300 Wast Oak Sweet 124 Sycamore Street 205 Wast 91h Street Stockton,California Lodi,California Manteca,California Tracy,California ES 9 REVI5E0 8-59 2M 5-62 ATLAS