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FOR OFFICE USE: jj * ------------------ -------------------------- --------------- .. w �PermitvNo. 1.. � ----------- -------- - - - APPLICATION FOR SANITATION PERMIT ---------------------------------------- --------------- .� (Complete in Duplicate) ----------------- ------------------------------------- - Date Issued � ..f - ------------ - This Permit Expires 1 Year From Date Issue 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. s - - � �!2 JOB ADDRESS AND L ATION_____________ ____ ____ I Owner's Name----- trz��-------•-- - , = ------------------------------------------- ---------------- Phone_.-- I ,f _ -----•-----------------------==------•--------------- Address--------------- :- ( ' -------- Phone-----------------------••---------- Contractor's Name------�,r� = Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court Motel ❑ Other El Number of living units: -------- Number of bedrooms -------- Number of baths -------- Lot lsize --------- �i� -=--r -R -- ------ Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table,l_ 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 ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ `�` TYPE OF INSTALLATION AND SPECIFICATIONS: v (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ptic k� Distance from nearest well_________________Distance from foundation_-----------------Material------.--------.--------------------------------- C << No. of compartments'-- --- Size—------------------------------Liquid depth--------- ------ Capacity-- -------------- Distance to nearest lot line---------------- Disposa�ie-A Distance from nearest well-----------------Distance from foundation /'6 Number of lines-------------------------------- --Length of-each line-------------- ---------- ----Width of trench------------------------------------ Type of filter material-------------------------Depth of filter material-----------------------Total length----------------- .---------------------- ' ______.Distance to nearest lot line_ -n{'�'' See— .�P't: Distance to nearest welL_.__�i✓ ( Distance, om fou dation___ rj((. Number of pits--____. __. __Lining material__'e -.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 and/or repairing {descnbe):__-_-• ��-------•- 1 ----------------- --- s ----- y,. ------------- ----- � 1 f --------------- --------------------- q ---------- - l Hereby certify that have prepared A" application and that the work will be done in accordance with San Joaquin County ordinances. State laws, d rules and re a.' s of the San Joaquin cal Health District. a �� and/orContract (Signed)__. caner � - ..-. --- 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 BY- ------------------- ----------------------------- DATE----------�-------~-Cd- .7-------------------- REVIEWEDBY----- --------------- ----------------- DATE----------------------------------------------------------- BUILDINGPERMIT ISSUED-------------------------------------------------------------—-------------------------------------• DATE----------------------------------------------------------- Aiterations and/or recommendations--- ------- ------------------- - -------------------------------------------- ---------------------------------- - •----------------------------------------------------------- - - ------------- --------------------------------------------------- I - ----------- -- ----------------- ------------------ ---------------------------- ------ l ` FINAL INSPECTION BY:. - - --------- Date.-- _'/_-----,------- SAN JOAQUIN LOCAL HEALTH DISTRICT I 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stocklon,California Lodi,California Manteca,California Tracy,California F.P.0 Q.