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R OFFICE USE:yip _____li _// �_ s APPLICATION FOR SANITATION PERMIT Permit No. __�-.r�_-- ----------------- ---- ------------------------ ---- ----------------------------------------------- --- (Complete in Duplicate) Date Issued ----------------------- - --- This Permit Expires l Year From Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct an .i stall the ork he ei d scribed. This application is made in compliance with County Ordinance No. 549- -OwneJOB ADDRESS AND LOCATION------- ------ ------ Owner's r's Name----. - --- Phone_- ---_------------------------ f Address------------- ------ - ----- ----- ----- Contractor's Name------ ---"�f= . ------•---------------•-------- Phone_z7�`" ,z , Installation will serve: Residence �artment House ❑ Commercial ❑ Trailer Court ❑ Motel F1Other El i Number of living units: _=X Number of bedrooms_—S-_ Number of baths ._:-ot size _ --------------------- -- ------------ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ----- 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 ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Se .c Ta): Distance from nearest well--------------_-Distance from foundation--------------------Material-----_--_-------__--------------------------_--. ��-No, of compartments---- •------------�-Size------------------------- Liquid depth Capacity. = f � f ��"___-Distance from foundat' n-"_ I Q• os�DF, .r.� istance from nearest well.-. __ -" !_�-_----Distance to nearest lot-line-----_-��_ Number of lines---- Length of each line_-_-fC4 E?_ Width of trench _,_"--------- ------ p Type of filter material _��4�e:_'f1-�---_Depth of filter material------� _4_f__-_Total len th-__--------- -- ----------- q. l-- g Seepage Pit: Distance to nearest well----------------------Distance from foundation-------------------- Distance to nearest lot line_____________"__ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter------_----------------Depth--------------------_----------- Cesspool: Distance from nearest well----=------------Distance from foundation---.-----------------Lining material------.--------------.------------_. ❑ Size: Diameter--------------------------------------Qepth--------- ---:------- ------ ----------------- ---Liquid Capacity------------------ -------gals. i Privy: Distance from nearest well--------------------------------------.-----------Distance from nearesf building--------------__---------_---------_----. ❑ Distance to nearest lot line------- ------------- --------------------------------------------------------------------------------------- Remodelin and/or repairing describe - ------------------------ -•-`�- -- """"""" ------------------ -------------- ---------•-•- --------- - - ----- - .- - " -- ----- -- - --------- --- ----------- ------ -- ------------- I hereby a fiify that I have epa d this application and that the w A will be done in accordance with San Joaquin County ordinances, �4aws, d rules and egulations of the San Joaquin Lo ealth District. yti (Signed)------------------------- LV Owner and or Contractor - - ------- - ------ Title - - (Plot plan, showing size of lot, location of system in rela '- to wells, ut i s, etc., can be placed on reverse side). F R EPARTMENT USE ONLY APPLICATION ACCEPTED _ ------' =•------ ------------------- ------ ----------------- DATE----- '---------------------------------- REVIEWED BY--------------------------------------------- - DATE----------------------------------- ------------------------ ----------------------------------------------------------------------------------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE------------------------------------------------------------- Alterations and/or recommendations--- ---------------------- --------------------- ----------- -----------------------------------------•-------------------- ------°--------------------------- ------------------------------------•-------- --------------------------------------------------- -------- -L�L---___-__;____-- ---- -- Date t --------------------------------- FINAL INSPECTION BY:. S JOAQUIN LOCAL HEALTH DISTRICT I 1601 E.i4axelton Ave. 30 West oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California ,Tracy,California ES 9 REVISED 8-59 3M 3•'63 F.P.CO.