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rUK UI-FICE USE: ------------------------- ------------------ ----------- _ _________ APPLICATION FOR SANITATION PERMIT Permit No. GJ}� -------------------------------------- -------- -------- (Complete in Duplicate) --- ----------- ------- -------- This Permit Expires 1 Year From Date Issued Application Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work here-:n described, This application is made in compliance with County Ordinance No. 549. JOB ADDRESS AN14�D OCATION_ ' ftp j /o., r Owner's Nam:;_�o � "� -----------------------------------=•'--- ----- -------------------------- ---------- PhoneAddress.---------- -----------•-••------------------------- ------------•-------••,---- �,iclence - --.,....----•--••- Contractor's Name,____ ----------- Phone---------------- -Installation will serve: RApartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _-r___- Number of bedrooms __Number f baths/___ Lot size ------------------- Water Supply: Public system ❑ Community system El Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobeardpan ❑ Previous Application Made: (It yes,date----------- --------) No ❑ 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.) Septic ank: Distance from nearest well--- _, Q_°__Distance from foundation------J_A_:�.. Material__.•--__- - _ No. of compartments------- ------------------Size_s� ,d`-9 �lr_-S---Liquid depth__---! ---_-------------Ca aci 40 Field: Distance from nearest well_--r,5` ._`__Distance from foundation. ` �F'4- -is Number of lines---------- -----------------------Lengthof each line----- -Da-__�-----__--.Width of trench---- - _` Type of filter material___----; ._:R-,_- __Depth of filter material____-/- --."__----Total length /-_(�_4_T_---__---- x Seeps e Pit: Distance to nearest well...... D G / . _______Distance from oundation_____«---------Distance to nearest lot line----- Q Number of pits__________ ________Lining material___-__-.�.� —'--.-Size: Diameter---- 71 Depth-- - Cesspool: Distance from nearest well F.__..--. 'Distance from foundation____---------------Lining material____.-_____._-_.________ _.: .; _.. ------------ ❑ Size: Diameter------------------ -------- ---------Depth-------- -------------- r ••---------------Liquid Capacity------ -------------------gals. Privy- Distance from nearest❑ well___ '_ " ____Distance from nearest building Distance to nearest lot line_-_.__._------------------------------___-_ --------- ------------------------- Remodeling and/or repairing (describe :__. ... ---•--------------•------------------------------------------ --------------------------------- ----------------------- ---------'-------------••--------------------------------------------------- ! hereby certif that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Stat , and rules and 4ulan, f the San Joaquin Local Health District. (Signed),------- --- ----------------------- BY�------�":`�'`�------ --=-'-•----- _ � r Contractor] ctor] ------------------------------------ -- ----------(Title)--------- = (Plot plan, showing size of lot, location relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___ .. ' ----------REVIEWDATE `f -G G ---------------------------- ED BY----------------------------------------------------------- ----- ---- DATE -- ----------------------------------------------------- BUILDING PERMIT ISSUED ----------------- ------------------------------------------------------------------------------------------------------------------------------------------ --..._ DATE. Alterations and/or recommendations:-_..__.__-- ------------------- ----------------------------------------------- ------- - - FINAL INSPECTION BY / ............. . -------- Date--- : . SAN JOAQUIN LOCAL HEALTH DISTRICT 7607 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street .205 West 9th Street Slockton,California Lodi,California Manteca,California Tracy,California F.P.cn. -