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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. ....................... ------------------------------- ----- [Complete in Duplicate) Date Issued ._8� 1_ (�'- 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 Ordinance No. 549. F ,old �� J ✓J/, -' JOB ADDRESS AND'LOCATION "?�--� � -- Phone , �Owners Name- --�:'-V L ----- 1 �• ...... s ,-_J. --------•-------•---•------------------- Address--...---- ) -�'-!} �---------- •---------- •-------- -------------- .,. _ ' Phone--------------------••---...------- Contractor s Name------`-.----�,�-�-�---�-- - -- - -- - - --------- - =-------- ---- -- ----- Installation will serve: Residence [�kpartment House ❑ Comrrtercial E] Trailer Court ❑ Motel E] Other E] Number of living units: __!___ Number of bedrooms --A- Number of baths Z.- Lot size �-�-,`- t1 i Water Supply: Pub4ic system'❑ Community system Private [:] Depth to Water Table 6 ft. Character of soil to a depth of 3Afeet: Sand E] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe rdpan ❑ Previous Application Made: (If'yes,date---------------_----) No [ New Constructiorn:.,Yes ❑ No ��FHA/VA: Yes ❑ No ®,r. ., ,. TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted,if public sewer is available within 200 feet.) Septic Tank:. Distance from nearest well2�_____________Distance from foundation--------.----------.Materia4------------------- ------------------------------ tments_--'-------------------`-Size------------------------ s--6 No. of compartments:- Liquid depth Capacity Disposal Field; Distance from nearest well--� ._Distance from foundation____._ -_____._.Distance to nearest lot line_ ' ____._. -Width,,o trench.,------ - �� Number of lines------- ---._.f_ .__ engfh of each line_-- o ---------------- �1 e th of filter material_.`�_ ______. g Type of filter material__ _ !� � p Total len th__ _ ______________��__-___-_- �* 1. .�- Distance fro foun ation__�________ __.D'stance to nearest lot ine______ _ _ ___ Seepage Pit: Distance to nearest'wel!_____ _d _._ <l - ---Lining material__f_.f,J_t'_ ize: Diameter _.. --Depth_- Number of pits_--__�----.__-- f ' Cesspool: Distance from neaest well-----------------Distance from foundation.- ---------------- Lining material_----------------------------------- gals, �') El Size: Diameter- ----�-- ------- ..Depth---- ------ -----Liquid Capacity- -----------=-------------9 Privy: Distance from nearest Weil.---- -----------------------------Distance from nearest building------.------_------- -----------------... ❑ ,. Distance to nearest lot line ------------- ----- --- -----=---------------.-_.:-------------------------------------- Remodeling ---- --------------- ------------- ----=------- ---------- �y /' r! / _ �-*=------------------------- i Remodeling and/or repairing {describe):------------- , i ----------------------------- -------------------------- --------------- ----- G - ------------------ - -------- ------------------------------------------ - ------------- -- ------- I I hereby certify that I have prepared +his application an 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, Contractor) (Signed) --------------- ---t---------------------- ----------- 1111 --�f_ ----- f �` � �I / ------- - [! --- -(Ti le)- �?...%�� = .... By:------------ ----- ----- -- -- -- - t (Plot plan, showing size of lot, location of sys+em" elation to wells, buildings, etc:, can.-be placed on reverse side). FOR DEPARTMENT USE ONLY I I � APPLICATION ACCEPTED BY---------- 4 -------------------- DATE----- ------- � REVIEWED BY------- ------------- --- ` ------ - --------- ------------------------------------------ --------------------- --- DATE-------------------------------------------------------------- - - BUILDING PERMIT ISSUED.___ -------------------- 3DATE-- - ---------- - --------- -----------fl ---___--• �_-- --------•------------- Alterations and/or recommendations:.......... ----------------------------• •--------•------------ ( ----------------------- -------------------------- --------------I-------- ---------------------- ------------------ _ -------------------------------------------- ----------------------- ----------------------- --- ;... � � FINAL INSPECTION BY------- ------- . --------- Date--------- ------- --------- - ----- --------- --------------- SAN.,JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ada.' • ' .•300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California F.P.CO.