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APPLICATION FOR SANITATION PERMIT Permit No. .- '- -- (Complete in Duplicate) ��: `- Date Issued ---------------------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. r This applicatiori is made in compliance with County Ordinance No. 549. + _ i C' .., `- JOB ADDRESS. AND CATIA----- - -- ------ ----- -------------- -- � -----------------~ -- -- Phone------------------------------------ Owner's Name =------ ---- -------- - - -- - Address ---------------- . Contractors Name----------- ------- `�? Phone n House �mercial Trailer Court ❑ Motel ❑ Other Installation will serve: Residence ❑ Apartment ❑ ❑ 1 ry S�yv� Number of living units: ________ Number of bedrooms _ Number of baths -------- Lot size _________r___________ Water Supply: Public system ❑ Community sys em ❑ Private 1?-"Depth to Water Table Character of soil to a depth of 3 feet: Sand Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: Yes ❑ 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 jprrK Distance from nearest well_. Of_-__Distance from foundation_--_1_ __:_.__.__.Material___ _______________________- No. of compartments-------�--------------Size--9_?�-_DLX- --------Liquid depth-----4------------------Capacity---�� ------ Disposal. Field: Distance from nearest well-J0-�_____-.Distance from foundation----1�-----------Distance to nearest lot line___S_- -___- lr- Number of lines--------/----------------------- Length of each line---------'S_U--`-----------.Width of trench__2.Y`----------------------- C Type of filter material--Y�4A�,--.----------Depth.of filter material-------I_?__-..........Total length--------Vc71'--------------------------- Seepage Pit: Distance to nearest well----------------------Distance from foundation_____________...___.Distance to nearest lot line_-----------A.. ❑ Number of pits----------------------Lining material ----------------------- Diameter-----------.-----------Depth------------------------------- Cesspool: Distance from nearest well-----------------Distance from foundation--------------.____.Lining material-------- --------------------------;di 0 Size: Diameter------------------------- ------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Priv -Distance from nearest well------------------------------------------------- from nearest building__________.__------_-_________________._. ❑ Distance to nearest lot Iine------------------------- ------------------------------------------------------------------------------------------------------------------ Remodelingand/or repairing (describe):------------------------------------------------------------------------------------------------------------------------------------------------------ -----------------------------•--------------------------•---•------------------ -----------------------------------------------------•-------------------------------------------------------- = ---------- I --------------------------------------------------------=--------------__1_1-------------------------------------------------------------------------------- ------------------------ --•-- ---------------------------- C I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County In ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. ' (Signed " �--------- ------------------------------------------(Owner and/or Contractor) 16 �,` e± tz-- - ---------------- s{r ( Plot plan, showing size of lot, location of system in relation to wells, build., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEDf_-- f ---- DATE-----�_�1 L-5 - --------------------------- REVIEWED BY ------ ------------ ---------- DATE---._�! 3-.17_' ----------------------- BUILDINGPERMIT ISSUED------------------------------------------------------------------------------------------------------ DATE----- ------------- -------------------------------------= Alterationsand/or recommendations:------------------------------------------------ ------------------------- - - - -------------- -------------------------------------------------------- -•------------------ -•---------•- ------------------------------------------------------ •- ------------------- ------ ------- ----- ----- ------------------ ------------------------ --------------------------------------------------------- ------- ----------- --------------- - -- ------~ --- -- -- -------------------- 1-114 ---------------- -----------------------•--•---------------- ----------------------•--------------- ---- -------- - -- - --- 'FINAL INSPECTION BY---------------------------------------------- - ------------ Date---- - -------------------------•----------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 3 _ 130 South American Street 300 West Oak Street 132 Sycamore Street s ""E!-4'Nor+h "C" Street Stockton, California Lodi, California MEanteca, California Tracy, California ES-4-2M Revised 1-57 F.P.CO.