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FOR OFFICE USE: s --------------1Q�9 _-- APPLICATION FOR SANITATION PERMIT Permit No. ------------------------------------------ (Complete in Duplicate) -_. Data Issued _-----------__-----_------------------------------------ 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. JOB ADDRESS AN OC TION-__/_ _o`-' _I ,� "' �� Owner's Name.------- - - -- - - --- -- Phone----------------------------------- Address ------- ------------------------------ --------------------------------- ------ Address-----•----•----- •---- oo� ---------- -- - ------'----------------------------------------------------------------------------- ----------------------------------- Contractor's Name------------------ /� = -----�---- --------------- --- Phone----------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court {] Motel [] Other ❑ Number of living units: _Number of bedrooms-_ Number of baths -A Lot size _____________________ Water Supply: Public system Community system El Private E] Depth to Water Table ft Character of soil to.a depth of 3 feet: Sand ❑ Gravel ❑ -Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe iardpan ❑ Previous Application Made: (If yes,date-----------:--------) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ - l 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_________________Distance from foundation--------------.-----Material-------------------------------------- ________- �� No. of compartments--- --------- ------- --Size--------------------------------Liquid depth---------- ---------------Capacity---•------------------- r -.Disposal Field: Distance from nearest well_________________Distance from foundation______.___.._____._. Distance to nearest lot line________--------- —7 Number of lines---•------------------------------Length of each line------------------------------Width oftrench-----------------------------__-- d Type of filter material________________________Depth of filter m terial______________________Total length ------------------------ N Seepage Pit: Distance to nearest well.__-.r,_-- -_-_--Disfan m found tion__�,�r__---_- Di tante to nearest lot liner ip ------------- Number of pits.... .............Lining mat ial_ __ - ize: Diameter__ p t De th --.1 �� __r tj Cesspool: Distance from nearest well-----------------Di ante from ndation-------:------------Lining material-.___--------------------------------. 0 ❑ 'Size: Diameter---------------- ---------------------Depth------------------------------- -----------------Liquid Capacity----------------------------gals. ; Privy: Distance from nearest well_________�...____.___________________________Distance from nearest building-----.------------------------------------ � ❑ Distance to nearest lot line---- ------------------------- - -- - ---------- --------------------------------------------------------------------------------- - -------- -- Remode4ing and/or repairing (describe)--- ----- ----- ----------- - •-----•-- - ---•---•---•------------------------------------------------ -------------------- ------------------------------------ ---------------------------------------- --------------------------------------------------------------------.1-------------------------------------------------------------------------------------------- ----------- ---- -------------------------------------------------------------------------------------------•------------------------------------------------------------------------------------------------------------------------------ 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 ales nd regulations of The San Joaquin Local Health District. (Signed)----------------- LV_ ___ -_ --------- -------- ------------ ----------------- - ----- or Contractor) By------------------------------------------------------------------------------ --- --- ----------------(.Ti+le)_._ ._--- - ------------------- - - (Plot plan, showing size of lot, location of system in r i on to wells, buildings, etc., can be placed on reverse side). I� FOR DEPARTMENT UJSE ONLY t APPLICATION ACCEPTED BY--- __1q1 --- ---- --6 ----- - DATE-------�A-/ ---------------------- - REVIEWEDBY--------------------------------------------- -- --------------•-- --------•-------------------------- DATE BUILDING PERMIT ISSUED--------------------------- ----- �r DATE - - - Alterations and/or recommendations:--- � � .� v --------------------------------------------- --------------------------- --- -- - - ------------------------------------------------------------------- ----------------------------- --------------------------------- ------ ----------•---•---------------------------------•------------------------ ----------------------- -------------------------•----• -- ------- ------------------------------------------------------------------------------------------------------------------------------ •------------------------ -------------------- --- - -------------------------------------------------------------------- --•-------------- ------------------------------------------------------------------ ---------------- -- FINAL INSPECTION BY:.- - �� D - ------------------- .-------------- SAN JOAQUJIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Are. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slockfan,California Lodi,California Manteca,California Tracy,California L