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FOR OFFICE USE: - ------ -- ----- ------------------ -------------- ---- - --- ------------- APPLICATION FOR SANITATION PERMIT Permit No. .. .__._....__....� ' -- ------ - ---- --- -- -- --- --------------------- (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. 0 JOB ADDRESS AND I CATI%4r ---------- Owner's Name---------- lrl 'Q_. -Q .. "_ A4-- _ - lPhone ---------- Address _. •- ------- Contractor's Name-------- -- --- -- .-• - --- ----- ----- -- --- -- -- ----- ----._ Phone46&�WV_. Installation will serve: R idence ❑ Apartment House ❑ .Commercial ❑ Trailer �JK Motel ❑ Other ❑ Number of living units: _r.._._ Number of bedrooms __1 Number of baths Lot size ---rZ--- ------ ---- - -------_-___._.._-_-_--_---._ Water Supply: Public system ❑ Community system ❑ Private X Depth to Water Table�_ it Character of soil to a depth of 3 feet- Sand Yom, Gravel X Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan E❑ Previous Application Made: (If yes,date-_................. 1 No New Construction: Yes ❑ No FNA/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_/W�__Disfence'from_foundation.... 0..f.-_ ----------- 5r —.. No. of compartments_.�__-._._... __Size_ __ ._X--f-:_-_Liquid clepth__.5:_7..t_fCapacity_-- 00_ Disposal Field: Distance from nearest well---745r�--.-Distance from foundation-_�Q_�__._.Distance to nearest lot line-- -------- Number of lines._ -. _. . Len th o€ each line____ --�-- g /-�L�'__ �r_-.Width of trench-----�'�_-_'�-�--------------- 1: Type of filter material_ _ -----Depth of filter material----.::/.T__.____Total length------�Q __._-____-___-- Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- + ❑ 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 a ------ - ----- ----------------------- --------------------------------------------------- ---- ---------- Remodnd/or repairing {des rib __ - --------------------- --------- ---- ----- ------------------------------•--------•--------------•------------------------------------------------------- -------------•------------------------- -__---------- I hereby certify that I Xeld this application and that the work ill be done in accordance with San Joaquin County ordinances, State laws, andgulations of t San Joaquin Loc ealth District. 5i ned -- - --- - --- ----- ---- -- ---- ---------------------- ----------...(Owner and/or Contractor) B (Title)_Y •-------------------- ------------- -- ---- - --- -------- ---------. . - (Plot plan, showing size of 1 system in relatio to wells, buildings, etc., can be placed reverse side). 3 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY ------------ DATE _' REVIEWEDBY---- - ---- ------ ---- --- ----------------------------- - -------------------------._ DATE BUILDING PERMIT ISSUE -- -- ------------------------------------ ---- -------__------------------- ------------- DATE-------------------------- Alterations and/or recommendations:---------------- --- ....... ---- -----•-•--- -- ---------------------------------------------- ---------------------- •-------------------- --- -------------------------- -------- --- --- ------- -------- -- -- ---- ---- --- FINAL INSPECTION -------- ---- - ---- - -- --- - --- ZDa e-------•----------- `-'-----��-�---L- --- � ---------------------- SAJOA UIN LOCAL HEALTH DISTRICT 4 , i 1601 E.lMa: on Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Slockton, California Lodi, California Manteca, California Tracy,California E.H.9 2M 1-67 Vanguard Press