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FOR OFFICE USE: `' "° QEin+1 APPLICATION FOR. SANITATION PERMIT Permit No. ------------ --- {Complete in Duplicate) Date-Issued __ ---------------------._- ------------- This Permit Expires 1 Year From Date Issued w 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 LO ATIO ----_ ��~--�r--!/fd'' � - -- --•-------------------------------------- ----•----�. Owner's Name---- - Phone. F r Address--------- -- - -- ��-'--�-----------• ----------•----- --F - --------------------------•----•- -- _ -- -- ------ Contractor s Name------ " ----- Phone Installation will serve: Residence ❑ Apartment House ❑ Commercial railer urt ❑ Motel ❑ Other ❑ Number of living units: Number of bedrooms ---- Number of baths _ - Lot size -------------------------------- Water Supply: Public system [Community system ❑ Private ❑ Depth to Water Table It. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy loam ❑ Clay Loam ❑ Clay E] Adobe�ardpan C] Previous Application Made: (If yes,date------- No [ao"'New Construction: Yes n< t❑ FHA/VA: Yes ❑ No gj- 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 gg-- Distance from foundation__1�_______._.Mat�ia�i_ 1' ---------- ®� No. of compartments---.-ate- -------- Size" - Liquid depth / Capacity.. -. Disposal Field: Distance from neares well___�~'_____Distance from foundation AP_.�-h__�,Mance to nearest lot line__-�__- Length of each line_ - Nidth of trench__J- Number of lines-----------------.f- 9 / i Type of filter material- 10 Depth of filter material_-de-�-------_---.Total length___. - ________________________ F 0 Seepage Pit: Distance to nearest well----------------------Distance from foundation_____________.____.Distance to nearest lot line-----------------❑ Number of pits-------{--------------Lining material_---------------_ - --.Size: Diameter----------------------Depth-------------------------------- • In Cesspool: Distance from nearest well---------._.- -__Distance from foundation--------------------Lining material--------------------__._.__----____- ❑ Size: Diameter--------------------- -- -----------Depth---------------------------- - ---------------------Liquid Capacity---------------------------gals. i t Privy: Distance from nearest well-------------------------------------------------Distance from nearest building------------------------.----------------- ❑ Distance.to nearest,lot line------ -------------- ---- ---------------------------------------------- Remodeling and/or -repairing (describe):-------- --- - � �"� ------------- ------------ -------------- ------------ _ E --------------------------------------------------------'----------------------------------------•------ -----------------------•---------- ------------ p ' 1 ------------------------------------------------- 1 ---------------•--------------- ----------------------- -- _... ~ -----------------------•-----------------•---------------------------------------------- ---------------------•------------------------------- I ------------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 regul a ions of the San Joquin Local Health District. (Signed) ---------------------------------- Contractor) -------- ------------------ l "----- (Plot pian, showing size of lot, location of system in rel to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY l APPLICATION ACCEPTED BY- 01------------------------------ ------ ---------------------------------- DATE__3i - - DATE REVIEWED BY------------------------- ---- BUILDINGPERMIT ISSUED------------------------------------------------------------- ----------------------------- DATE--------- - -------------------- ---------------------------- Alterations and/or recommendations:------ ------------------- - ------•---- - i -------------------------1-------------------------------------------- ----------- -- ° ------%L Date-- ------3�1---1- -bb -- ------- ------- ------------------ --------------- o - FINAL INSPECTION BY:.. a ---------------- ---------------- - ----------- SAN JOAQUIN LOCAL HEALTH DISTRICT t -- r 1601 E.Ha=elton Ave. 300 West Oak Street 124 Sycamore Street { 205 West 9th Street r Stockton,California Lodi,California Manteca,California y Tracy,California F-P.C o. � ski