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I-UK UtrlC.t USt: --- ------- ------------------------- ---- -- --------------------------------------------------------- -..-._..---___........................................... APPLICATION FOR SANITATION PERMIT Permit No. 59 ---------------------------- ------------------------_ (Complete in Duplicate) --------- ------------------- This Permit Expires t Year From Date Issued Date Issuedlts_.7_ .7 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--- Owner's Name-A-- k--- Address------------------- --Address------------------- Contractor's Name---------- ----•-------------•--------------------------------------------------------------------------•-------------------- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms -------- Number of baths -----.__ Lot size _.-.....- ---------•-------•----------------------- Water Supply: Public system ❑ Community system ❑ Private JZ 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 64 New Construction: Yes ❑ No 4 FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available wi+hin 200 feet.) Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material----.-...........-..-__.__.------..--__-.-__---- ❑ No. of compartments--------------------------Size--------------------------------Liquid de th----.---------------------Capacity - Disposal Field: Distance from nearest well___.............Distance from foundation-------------------.Distance to nearest lot line_-.--._...------- ❑ 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 line----------------- Number .----.- -_--- 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-----------�---�----------------------- ----- ------------------------ R ---------------------- Remod lin an or re airin describe :. � ._ .-.__._!__t ._�1 fi i �d,�n`�-5 �'t {cif a2��}� y� l 'tJ Yi Yt Q C Pg -- -------------------- ---- ------------------------------}-------------------- -TO-------------------- ---------- ----- -------------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------_-------------------------•------ ---------------------------------------------------------- ---- ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------------------ I hereby certify that 1 have prepared this application and +hat 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)--------- / l ------------ ------------------------------------------ .........(Owner and/or Contractor By:------------------------------------------------------------------------- --- ---------------------------------------------------.(Title)--------- --------------------------------------------...... (Plot ------- ---------------------------- ----.----- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT U E ONLY APPLICATION ACCEPTED BY-Z --•----- - ----- - DATE-- ,�� REVIEWED BY ------------------------------ DATE--------------.------- BUILDINGPERMIT ISSUED------------------ ------------------------------ ---------------------------------------------------- DATE------------------------- ---- Alterationsand/or recommendations------- - - ----------------------------------------------•-------------------------------------• ----•------•--•-------------•------------------------------- -- ---------------------•----------------------------------------- ----------------------------------------------------------------------------------- -----•----------. --------------------------------------------•------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------- va�t FINAL INSPECTION BY:_ U' Date .� - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stockton,California Lodi,California Manteca,California Tracy,California F.P.a 0.