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f rVR Vrr o-r uz)t: _.. ............. ..... . .. .... ��LICATION FOR SANITATION PELT Permit No. .: -_.:.` .�f ' ...... ........... (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 AND LOCATION-:/----• --- -- OwnerOwner's 's Name.----------- ............. ........................ ............ . . Phone.-- .......................... Address---------_. ----------------- Contractor's Name----------------- --------- ----•---- --.-- -....---..................- - -...- --.--------..... Phone--------- ------------------------- Installation will serve: Residence E] Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of Irving units: i._..... Number of bedrooms .- Number of baths -_.._-_- Lot 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 0 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.) Septic Tank: Distance from nearest well.................Distance from foundation___.---------...._Material......__._____-............._...--..__-.-------. ❑ No. of compartments-.---- ..............Size----------------- --- ----Liquid depth--.-----.... Capacity... ...... -------- Disposal Field: Distance from nearest well.................Distance from foundation--------:_..........Distance to nearest lot line_,_------------- 171 ine-._._....------- ❑ Number of lines-----------------------------------Length of each line........ ............-- -.Width of trench..:---------.--------. Type of filter material_ Depth of filter material.--------- ...--.-Total length-----, ------------------------ --- Seepage Pit: Distance to nearest well......................Distance from foundation..:-._-- --------- Distance to nearest lot fine__..........-:._- ❑ Number of pits.......................Lining material.-------.------... -- Size: Diameter..-----------------. Depth_......:---------................ Cesspool: Distance from nearest well-----------------Distance from foundation. _... Lining material-._ ___-------.--------_.-.--------- ❑ Size: Diameter. -- . ---... _---- --- - --------Depth---•------- ......... . .....-...... -----Liquid Capacity...----------- --- gals. Privy: Distance from nearest well__ ---------_-..:------------- _..____ _Distance from nearest building.------------- .. . ❑ Distance to nearest lot line---------------------- Remodeling - -- --------.---- 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, State laws, and rules and regulations of the San Joaquin Local Health District. (Signed)- = --------------------- ----------- -% - -------� (Owner and/or Contractor) By�---------------------------------------------------------- .......... -- -- -----(Title).------ - -.- - -.------ (Plot plan, showing size of lot, location of syster» in relation to wells, buildings, etc., can 6e placed on reverse side). _ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY.-..-,,,- _.- - --------------------- -- --- --- - ----------------- DATE--- ........... ..._,!� '.._.. REVIEWEDBY - - ....... ...... ..... .......... ..............................._------ ....... DATE--- �f �-..-...--.........,._= - BUILDING PERMIT ISSUED.-,........ .......... ------- ---•------- ......................... DATE--.-- r` , �... �r'> Alterations and/or recommendations:................... .. �� d _ ...._._..._. -- -----...................................... ................. .. ..................... ...---- .-....._. _.....- _-........_ .---- ..- _._._.... .... . ........................... ... .. .............................. .... ...-.._-........................................--- ........... --- -....._.. .... .-................... FINALINSPECTION BY:..-...- ........ . .. ... .................................. Date........................--- . .. .... . ....... ....... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 51ockton,California- Lodi, Colifornia-I � Manteca;California- Tracy,California F,P.0 O.