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FOR OFFICE-USE: APPLICATION FOR SANITATION PERMIT Permit No. __ .---- --` . ---- - --------=------------------------------------ 1 --- ------------------ ---------------- --------------------------- (Complete in Duplicate) - -- - - ----------_--------------------------_---_:_..__-__ ___ This Permit Expires 1 Year From Date Issued Date Issued �l��o.� 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 A LO T13DN -------------------------------------------------------------------- Owner's Name ---------- Phone--------------------------i=-------- u �f .... Address-------------- -- - -- ----------- ---------- -- ----- ---------------------••- ------------------------- Phone--------------------------•---------...--------------...------- t Contractor's Name--------------- Installation will serve: Residence V__19partment 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 [�<Depth to Water Tabletjft! I Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑''Clay Loam ❑ Clay ❑ Adobe®- Sardpan ❑ f r Previous Application Made: (If yes,date_____ ______________I No [��New Constructi ni Yes ❑ No ❑./FHA/VA: Yes ❑ No ( -�- ` TYPE OF INSTALLATION AND SPECIFICATIONS: �f (No septic tank or cesspool permitted if public sewer is available within 200.feet.) ----------Mate,ial__ t' - F`---------------------- 'e -- Septic Tank: Distance from nearest w 1___��_ Distance fpm foundation_;.__Q f ,, 'e i f No.hof tom artments___ Size_ +�l+- �tlf�--F- Liquid depth-_." Ca pacity_�.r_l�_____ Disposal +Field: Distance from nearest well....71r------Distance from foundati n /t� -------Distance to nearest lot line_ 7r--_-_-- LT , f f Number 'of lines------ ----i-- -rr��-------- Length of each line----- '.-----f, Width of tren ----------•-----------------•- TypeYof filter material. ./L ZIeDepth of filter material-_ ______--------- Total length___ -------------------------------- W __' Diance fr""m"fnda"tion ._.___D� ante to nearest lot line__ ________ Seepage Pit: Distance to nearest well.__ r Number of its._. __ Linin materiaL _.Size:'Diameter_ __...______.Depth_saa �1/ X'____ pi >�------- 9 i t. r Cesspool: Dista`rce'fiom nearest well_______.___._-Distance from foundation._._..............Lining material---____-------------- _._._________. L1 Size:' Di meter.-.-----.:----------------1----------Depth------------------------------- -------------Liquid Capacity----------------------------gals. Privy: Distance from Barest w.ell----- -------------------------------------------Dist8nce from nearest building.----------------------------- 4 ❑ Distance to nna-rest lot line--- °---------------------- ------------------------------------------I------------------------------------------------------ Remodeling and/or repairing (describe:___ -------•----••-•--------------------------------------- t -------- ------•------------------------�_____ .---------------------------- = - --------------•------------------------ ---------------------------------------- --•-------------•-------------------------------- ------------------------------------- ---°----------•--------------------------------------•--•---------------- --------------------------------------- -----------------------------•---------------------------------- I hereby certify that'1 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. -� M ' __O�r:� or Contractor ' J --------- (Signed) ' ---- — fI ( / ) B : --------------------------------------------1---- (Title) ��lL y (Plot plan, showing size of-lot, location of system in r ation to wells, buildingrs,;etc., can be placed on reverse side). Z ; ! FOR DEPARTMENT USE ONLY APPLICATION ACCEPTEp•BY--------- --^-- -.1c!✓'-------- ----.--------- ---------------------------------------- -------- - - DATE ��/b��o�--------------------------- - REVIEWEDBY-----------------/--------------------------- -------------------- --------------------------------------/_N DATE----------------------------------------------------------- 11-� BUILDINGPERMIT ISSUED-`--------------------------------------------------------------------------------' 1 DATE - Alterationsand/or recommendations----------------------------- - ------------------- ------------•-----------•- ----------•--- •------------------------------------------------------------- ------------------------------------------------------------------------------------------ ---------- --------------------------------------------- -----------•--••-.-----------------------------•--....------------- ---------- FINAL 1,NSPECTION BY:..---- ------ ------ Date------- -¢---------------------------------------------- t USAN JOAQUIN,LOCAL HEALTH DISTRICT-% 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Sfoeklon,California Lodi,California Manteca,California Tracy,California a F.P.CO.