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v : OR OFFICE USE: - ,J J --- ----------- (_L-. ...... APPLICATION FOR SANITATION PERMITPermit No. " . ------------ ------------------------ �_ G S� je� v� =" All.3-t-1 _ (Complete in Duplicate) ---- -- /. Date Issued ---- ------------ ----------------------------- - " _ 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. ' J =-----_=---•-"-------=� - - JOB ADDRESS AND LOCATION------------------------- ------------_._ Owner's Name Phone + �. -------------------------- ---------------------------- ------------------- --------------- Address----•---------3 4--Z - �—,.`' ------------------------ = v 1 -yPhone --o --' '------ Installation ---- ---_---------------- Contractor's Name------=---- ------------- --- --; ------------ ----------- -- --- Installation will serve: 'Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel,O Other ❑ Number of living units: .------- Number of bedrooms __�-Number of baths --1.._ Lot size 4 ?c /- - -------------------- Water Supply: Public system E- Community system ❑ Private ❑ Depth to Water Table -------- ft. r. " o Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adbe.1 Hardpan ❑ Previous Application Made: (if yes,date-.___.----__....--) No 2r New Construction: Yes E] No [?3- FHA/VA: Yes ❑ No E!fr TYPE 'OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or-cesspool.-permitted if public sewer is available within 200 feet.) Sed is Tank: Distance from nearest well-----------------Distance from foundation__________-_______.Material--____.____________._______.________..:.__..__... No. of compartments_ Size___________________________ -•---Liquid depth-------- - --------------Capacity-------------i--------- --------------- --------- Disposal Field: Distance from nearest well-------_...____Distance from foundation---_------_-._-_.Distance to nearest lot line_________________ Number of lines-----------------------------------Length of each line--------------------- ------.Width of trench--------------------- ------------ -----------------------Total length._ Qj Type of filter material-------------------------Depth of filter material _"_______-___._-------------------------- Seepage Pit: Distance'to nearest well._._-.- m h t__Distance f om foundation----- X to nearest lot line__.____.__.-.- 0`� !f t Number of pits.^ /-----------Lining material..-----vim�[_--Size: Diameter------ - ------- Deptih------- --------- -------- N Cesspool: Distance from nearest well----------.-------Distance from foundation............... ....Lining materia ................... ......... y� Depth ........ --------Liquid Capacity.....-------------------•---gals. ❑ Size: Diameter---------=-- ----------------- ----- p Priv G om .nearest well------------------_._--__.___--.---------------Distance from nearest building.�_--------------------------- y _�. .�.. ------- Distance to neares ------------------------ i Remodeling and/or repairing (describe):--------------- -- ------------ •------- ------------------ - -------- ---------- ---------- - --------- ------------------- -- ----- --------------------- ---------- -------------------- -------------------------------------------------------- ---------•------•----•-------------- -- ---------•--------•----- ------- ----------- ----- ----------=--------------------------------------------------------- ----------- - ------------------ ---- -- --- --------------------------- 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 regulatione San Joaquin Local Health District / // ..............(Owner and/or Contractor) (Signed) .A By:------------ - ----- -------------------- ----------------------------------------------------------------- e) - (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-------------- 7-------------------------------------------------;------------------------------- DATE-- ----- --- ------0-------------------------- ---- i REVIEWED BY------------------------------------------------------------------- --------- ------ --- ----------- - ---------------- DATE----------------------------- ------------------------------ BUILDING PERMIT ISSUED-- --------------------------- --------------------- ------ l ----------------------- ----------- DATE------------------------------------------------------------- ---- F Alterations and/or recomme dations-- --- - -- ----------------- -:------ --------------- -- r ' - ----------------------------- --------- ---------- ------------------------------------------------- ------------------------------------ - ------------------------------------------------------ ----------------------------------------------------------------------------------------------------L..-•--------------•-------• 1 7 I FINAL INSPECTION BY:..----.---- ----- --------- -- - Date.. --------��--_�si_ �----T-----i------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT t y 1601 E.Hazelton Ave. 306 WesYOak Streets 124 Sycamore Street 2D5 West 9th Street Y t Lodi,California Manteca,California Tracy,California Stockton,califorma i F.P.CC.