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FOR OFFICE USE: ,1 -------------------- ------""------- ------ ---------".._ APPLICATION FOR SANITATION PERMIT Permit No. -...` -- -------------------------- -------- -----------"- - [Complete in Duplicate Date 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. c^, = ' ----------- "' ---- JOB ADDRESS AN LOCATION_.C4"--- ----------alp'-- --- ,�,y� ---------- -- ---- -- - Phone.----•----------------•---•---•---- Owner's Name--------- -----_----- --------------------•--------•--•--------------------- ------------------ [ Address Q'`r - --•---- - -eA. ----••-------------------•-------------------------------------•------------------------------•-------- fPhone----------------------------------- Contractor's Name - Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ._f----- Number of bedrooms ._3_" Number of baths "_....-- Lot size ............... ----------------------------------- Water Supply: Public system 1771tCommunity system El Private �epth to Water Table -6"+eft. Adobe Hardpan ❑ Character of soil to a depth of 3 feet: Sand El Gravel ❑,_,,S/an Previous Application Made: [If yesdy Loam ❑ Clay Loam ❑ Clay ❑,date-.__' .. .) No IJ New Construction: Yes ❑ No [ FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: ` [No septic tank or cesspool permitted if public sewer,is available within 200 feet.) �: -• :� .-, ...�... r�= -�. v ----- Material---------------------------------------- T -- ..? �" ---- ---- ------ --- -- Septic T Distance from nearest well--4-V------Distance from foundation" / i f Capacity L No. of compartments.__.. '�---------------Size._____I Liquid depth p Y = tance Disposal Field: Distance frominearest welLi:je. --------Distance from foundation.":- Width ofttrenc nearest ine.-.................,_-_. 41 t Number of lines- "" ---"-------- _-----Length of each line- - -- a g Depth'__Z"__..._De of filter material._""�_�--- qo --------Total length_.._" "------=----- - Type of filter material-.__"_. p i n n ,e nearest lot�ine_"�.._"....- Seepage Pit: Distance to nearest well__ed _ ".------Distanceeffrom foundation_ p............. to De th------ --- -------------Lining material..!-1- ---- - Size: Diameter---- - - P Number of pits._...- ' Cesspool: Distance from I'nearest well...___..---.....Distance from foundation-._-------------_.Lining material--_...-----._...-.----_._-.------"-- Li uid Capacity gals. ❑ Size: Diameter,..--- ----- ----Depth--------------------- ------------- --------- q p Y Privy: Distance fromnearest well.____..----.:_•_.---._----. -- Distance from nearest building-------------- ----------------------- ----------------------------------------------------------- Distance ---------------- ---------------------- Distance to nearest of i•ne- ------- ----------------------------------------- Remodeling and/or repairing (describe):.__..... -------------------------- ----------------------------------------- ' --- ------- -------------------------------------------------------------------------------------•---------------•------ ----- ----------------- --------------- ------------------------ --------------- I I hereby certify that ! have prepared this ap - -- plication and that the work will be done in accordance with San Joaquin County I ordinances, State law and rules and gulatio s of the San Joaquin Local Health District. -..(Owner and/or Contractor) (Signed)---------- _ ---- ----- - -- ---------------------------------- ----------------- - -- (Title---: By:------------- ------------- --------------- -------------- v .. . _.. . . [Plot plan showing size of lot location of system in'relation to wells, b'uildirigs, etc.an be placed on reverse side]. F R FOR DEPARTMENT USE ONLY ` APPLICATION ACCEPTED BY._ :--------- -- -- - ---------------- ------------ --- l DATE..-- , =r - - ------------- - - ' -------------- DATE----------- ----------- ----------------- REVIEWED BY- -------- - ---------- -------- --------------------------------------------------- - - -------------------- ----- -------------------------------------- DA --------------••-----------,---------- = BUILDING PERMIT 155UED--------------------------------------------�--------- - Alterations and/or recommendations:------------------------------------- -------- ----------------------------------- ------------------------- - ---------------- ------------------- ---- ---- --- ---------- - ------- ------ -•--------- ---------- ------------------------------- ------------ - -- / -- Date---- -- ----- - -----—- -------- FINAL INSPECTION BY:..-. SAN JOAQUIN LOCAL HEALTH DISTRICT J, 1401 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California 5tockfon,California �a �-- �� F.P.0 O.