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FOR OFFICE USE: - - S� Permit No. �1�•��---�� --------------- -15- - APPLICATION FOR SANITATION PERMIT ---- - --- (Complete in Duplicate) Date Issued larV 7''�G ----- ------------- -------------- -------------------- --------- This Permit Expires 1 Year From 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 Ord�inpr ce No.549. t; 2 .t� -------------------------------•----•------- J- - - JOB ADDRESS AND L C TION .� - Ph ---------------- '..s ----- \ --------------------- ------ " Phone Owner's Name. _ -- - �f`' --------•--------------------- - --- __. Address------- _ - ------•---- ----------•--- ------------------------------------------ --- - __:=:---- •--- -------------•---•-----•---------- - one.__..._- ------•--..... 7S ------ ---------- -------- Ph Contractor's Name--•---- Address-- ---------------- -------------------------- Other Trailer Court ❑ Motel ❑ �. !tent-House :Q Commercial.❑ _ -• Installation will serve: Residence ❑ p. , # --�Num�b�er of bedrooms.___-----�Number obaths-*"" "ot size ------------------------------------ Number ----------- .. Number of living units: ____ ,,,",�,,, Water Supply: Public .system ❑ Community system ❑ Private Depth to Water Table- ft'y 0 Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Graav�el ❑ Sandy Loam ❑ 'Clay Loam ❑ ClaGa, Previous Application Made: hf yes,date---------- ---- NNo New Construction: Yes ❑ No L� FHA/VA Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS:tpublic sewer is, within 200 feet.) (No septic tank or cesspool perm p ` ,, ( , 1�-- ------ Material-------------------------- ----------- ------ ------_' - _ -- Septic nk: Distance from nearest well t �___---Distance from foundation__ - V Size .2 ---------Liquid depth--------`"�- -- --------Capacity_--_ No. of compartments---3-------- - . Dis osal- .._Distance from foundation_/h_________.._.Distance to nearest lot line_ -- p Field: Distance from nearest wef� ---- � p� Width of trench___-___ -------------- f - Number of lines__-__ -.-- '' ---Length of each •liege_--.�- „ s� .. Type of filter material_�d��-- ----Depth of filter mater�eai__7r----...........To#al length --:----- --i---�----- ---------------- ,:, R G-------------Distance to nearest-lot line--- ------------ Seep et: _ Ristance to nearest well_1�--------� ---Distance from fours anon_____. Size: Diameter----A- --� Depth Number of pits_..._.`------------Lining material- Q_� -- -- ,. . Cesspool: Distancerfrom nearest well ------- Depth from foundation - ._ -:----_Lequid Capacity-._:.__. ___-__-- ----- -gals. ❑ Size: Diameter_____-- Distance from nearest well----------------------------------- _Distance from- nearest building------------------------------- ------- Privy: --------------- ------• --------------- -- Distance to nearest lot fine...__---------------- -------------------- :. ---------------- ., --'---------------- -------- Remodeling and/or repairing (descri e :__-._________-_-__-- 2 ___-__ ---- ------------------- ---------------- - ---------------- -------------------- ------------------ ----------------------------------------- ----------------- I ---------------------------------------------------------------- - ---- --------------------------------------------------- --------------------------------------------------------------- -------------•-----------_-- --------------------------•------------------ I hereby certify that I h e prepared this a lication and that the work will be done in accordance with San Joaquin County ordinances, State laws, and les regulon o he Sa Joaquin Local Health District. {O and/or Contractor) weer (Signed) --------- ----------------- -------- -- ----- I --- ------- -- --- -- - ------ --- - By:-------------------------------------------- I (Plot plan, showing size of lot, Iota+ion of sys+em in relation to wells, buildings, etc., can be placed on reverse s+ a:-�' FOR DEPARTMENT USE ONLY I G APPLICATION ACCEPTED BY_ ,-_.- --. ------ ------- ------ --------------------------=------------ -------- ------ DATE--- ------------- ------- ---- REVIEWED BY_ ---- -------------------- ----- ---------------------------•--- DATE------ --•---- -------------------------- ----•------------ ------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------- --------------------------------------------------------------------- - Alterations and/or recommendations:---------- -----------._---------- ----------- - r -------------------- --- -- -- aDate---- 1-b- 1 `--- ------------------------------- ------- FINAL INSPECTION BY:. -------------- SAN JOAQUIN LOCAL HEALTH DISTRICT I 1601 F.Ha:etton Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Lodi,California Manteca,California Tracy,California � Stockton,California