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FOR OFFICE USE: er. .. -- --- --- -- --- ----__--___._-_----- ----------------- APPLICATION FOR .SANITATION PERMIT Permit No. (Complete in Duplicate) ----_- This Permit Expires 1 Year From Date Issued 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 incompliance with County Ordinance No. 549. A,�,j .. ?,0']— U,Sp—CS J B ADDRESS AND L CATI N__._=- ----- ---'' ._IQ _� ----------- - - Owner's Name -----------------•----------••-----•--------------••------------------------- - ------------------------- ------- ----- Phone---... ..--------------- .......... Address........ FYI-[_----- y� -----------------------------••-•------••------------------------------------------------------------------------ Contractor's Name --- -------` ----------------------•------------------------------------------- Phone--------------------------•----- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: :-�_--_ Number of bedrooms __j----- Number of baths ---I--- Lot size ----/3__,,I, „�„l/L.c________________________ Water Supply: Public system❑ Community system ❑ Private [�pth to Water Table _.40 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date---------------------) No New Construction: Yes ❑ No �HA/VA: Yes ❑ No'tr' TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Ta?I Distance from nearest well----- Distance from foundation___________________ Material---..__________-._--_.._ . No. of compartments------.!_ _.J- Size------------------- --••=-----Lic{uid depth------.-------------------Capacity___•--------_----_----- � ---------- Disposal ield: Distance from nearest w` (..__._Distance from foundation-./11__*__.___._.Distance to nearest lot line__-�_`-. � Number of fines-------,1----_---------- --------Length of each line_-- f __-G_._____--Width of french-__-2�-'�__________________ Type of filter mater-ia1�0_L ....-_-Depth of filter material---It_____________ Total length----kf-..-------------- -----••---- . Seepage Pit: Distance to nearest well-__ ______________Distance from foundation------.------------Distance to nearest lot line_..__________-._ ❑ Number of pits----------------------Lining material----------------------Size: Diameter_--------------------Depth--------------------------------- Cesspool: Distance from nearest well-----------_-----Distance from foundation--------------------Lining material-_-.----.._..-.__________--..__--.--_ ' ❑ Size: Diameter---- ---------------------------------Depth-------------- -------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------__ ------------------------------------Distance from nearest building---.-------------------------.- ❑ Distance to nearest lot line--------------------------------- Remodeling and/or repairing (describe):-'---- '--------------------------------------------------------------------------------------•------------------------------------••------------------ ---------------------------------------------------------------------------- ---------------------------------------------------------------------------...----------------------------------------------=•-----•------------------------------------------------------------------------------------------ ----------------------------•----------------------------------- ----------------------------------------------- ------------------------------------------- - -- -------- I hereby certify that I have prepared this ppplicafion and that the work will be done in accordance with San Joaquin County ordinances, State law and rules and re a ' ns of a San Joaquin Local Health District. (Signed) --- ----- - ---------- --- -------------- ------ - ------------------------------------------------------- --------(Owner and/or Contractor) , By:-------------------------------------------------------------- -'---- ---------y---------------------------------------------(Title)--------------- -------------------------------------------- --- (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------- ` REVIEWED BY ' -u ----------------------------- PATE- _ ------ -------------------------- -- ------------------------------------ ------------------------------------------------------------------- DATE-------------------- ------------------- BUILDING PERMIT ISSUED--------------------------------------- ------------------------------------------------------------- DATE Alterations and/or recommendations:--------------------------------- --- - --------------------------------------------------------------------------------------------------------------- ----------------------------- ----------- -------------------------- ------------------------------------------ c+ •---------------------•--- --------------- - -----•--.. ---------------- -------------------------------------- --------- -------- ------- ---------------------------------------------------------- ---------- ------------ ----------------------------------=-------------------- - --- -- --- ------ --------------------------------------------- --------------------------------- ---------- - - -------------- --------- FINAL INSPECTION BY:.--- - � ------------- Date-.------ ---------------GS` SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slocklon,California Lodi,California Manteca,California Tracy,California F.P.0 O.