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rvK urrll.t Ubt: / - - �^--- --- ---- ---- - PPLICATION FOR SANITATION k .MIT Permit No. ../... ��. (Complete in Duplicate) -'--.--- This Permit Expires 1 Year From Date Issued Date Issued ________ 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 Ordinance No. 549. JOB ADDRESS ANP LOCATION- Q • ... -------------------------------....------------•-••------•--•-----•---•------------------------ Owner's Name-- 1-. l ------------------ ------------------------------- -------•------------------------------------------------ Phone------------------------------------ -- -- ----------------------------•-----•--•--------------•-------......---------•-------- _ -• ------------ ---••-.............. Contractor's Name------ Address............. _ ------•---------•-•-----------------------•--- -------------•------------------••----------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ - Motel ❑ Other ❑ Number of living units: Number of bedrooms __.Z Number of baths ---/-. Lot size .- f _ -_tea_----------------------------------- Water .__________________ _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 p Hardpan ❑ Previous Application Mader (If yes,date--------------------) No Ug New Construction: Yes ®' No ❑ FHA/VA: Yes ❑ No 9j-" TYPE OF INSTALLATION:AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well--�--------Distance from foundation---/4- -------Materiel.__I?�___ _ ___ __ ____________________ No. of compartments------Z---------------Size----* - -c `X-`� Liquid depth------f,----------------Capacity-_._g0.9 Disposal Field: Distance from nearest well----I__-____Distance from foundation-40._"________.Distance to nearest lot ✓__'__.._ Number of lines-------/--------------------------Length of each line_-91,p--'-_---------------.Width of trench.w-------------------_--- Type of filter materia�.�alp ________Depth of filter material__1g_a_________-__Total length____:_2Q---------------------------- Seepage Pit: Distance to nearest.well_.--.:--------------Distance from foundation_ZA_.............Distance to nearest lot fine----4._#.__- ®� Number of pits------ ---------------Lining materia? � ` ---- _ .. _ - � - Cesspoo• Distance from nearest well----_---------- from foundation-------------------.Lining material___-__._______-__________---_________- \ ❑ Size: Diameter----- --------------------------------Depth---•--------- --------------------------------------Liquid Capacity---.------------:_........--_gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building-----------------------__..:_____._______. ❑ Distance to nearest lot line--------------------------------------------------------------------- Remodelingand/or repairing (describe)=------------- ---------•--------------------------------•---•------------------------------------------------------------------------------------- ------------------------------------ ...... --------------------------•-----•-----------------------.----••--------------------....-----•------ - ------------------•-•--..........••----------------------------------••---------....------------•-•------------------- ------•---•------------------------------------------------------•.-------------------------------------------..------------------------------------------------------------------------------------------------------------ hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State laws and rules d egul tions of 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 ------ ---------------------- DATE �d ----- REVIEWEDBY--------------------------------------------------------------------- -- ------- -------------•----_------------- DATE - BUILDING.PERMITISSUED------------------------------------------------ --------------------------------•------- ---------- DATE------------------------- -------•----------------••--------.. Alterations and/or recommendations:--------•-------•----------- --------- ------------------------------------------------------------------------------------------------- ----------------------------------------- ------------------------------•-•.----•-----------------------------•------------•--•----------------•----------.........-------------------------...-----------------.------ -- -------------------------------- FINAL INSPECTION! BY: ! - ------------- Date- - y SAN JOA UIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Sire t 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.C o.