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FOR OFFICE USE: --- ----- w �" APPLICATION FOR SANITATION PERMIT Permit No. ' ------------------------------ ------ - (Complete in Duplicate)------------------------------------------mm==-E-==-=E--E 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 in complianccee�with County Ordinance No. 549. JOB ADDRESS AND LOCATION -- - -- - - - ------------------------------- Owner's Name---- d --- - ----- -- Phone------------------------------------ Address------------------ --- - ------------------------- Contractor's Name &51----`�j-- -----------------------------•------------------------------------------------------------------------ Phone----------------------------------- Installation will serve: Residence [A— Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --1.--- Number of bedrooms __s3__ Number of baths ---Z Lot size ----��__.x_ .6a_________________________________ Water Supply: Public system [Z— Community system ❑ Private ❑ Depth to Water Table ---0it. 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 ❑ ❑ [�FHA/VA: Yes No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) �� Septi ank: Distance from nearest well-----------------Distance from foundation------------------- Material............... � No. of compartments Size--------------------------------Li'quid de th------------ --------- P ------ q p ---Capacity------ - ------=------ .R 1 Disposal Rel Distance from nearest well..- -_-----Distance from foundation____�_Q__{.......Distance to nearest lot line ❑ �� Number of lines----/-----------------------------Length of each line----3-4_`-----------------Width of trench------ --4._".._._______------ Type of filter matenal___1C+��(C__-__---Depth of filter material___/t-------------- Total length v�� O Seepage Pit: Distance to nearest well._.. -----------Distance f.orn fa`undaf1iion___-.6A_`_--_..Distance to nearest lot line-67-------------- Number Number of pits______1_________-._Lining material_ ____] __ft.t= C1ife: Diameter--.-.3.,3. `"----._Depth_...__--•2.�5_'-------------- Cesspool: Distance from nearest well-----------------Dista e frogs466ndation-.__--_____.____._.Lining material---------------.____.__-.-----..-._-. •( ❑ Size: Diameter------------- -----------------------Depth--------------------- -------------------- --------Liquid Capacity----------------------------gals. Privy: Distance from nearest well-------------------------------------------------Distance from nearest building____.__---.--.--..-.------_----._--_.--._. I ❑ Distance to nearest lot line-- ------ --------------------------------------------------------------- ------------------------- Remodeling and/or repairing (describe�---------------------------------- - ----------------•----------------------------------------------- --------------------------•------------------------- ---------------------------------------------------------------------------- ---- --------------------- --------------------------- - E I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, State lap, and rules and regulations of the San Joaquin Local Health District. _(Owner and/or Contractor) (Signed)----------- -----=-------- BY:------------------------------------------------------------------------------------------------------------------------------------(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---------------- ------------- - -- ---------------------------------------- DATE------ REVIEWEDBY----- --------------------------------------- ---------------------------------------------------------------_ DATE---------------------- BUILDING PERMIT ISSUED-------------- --------- ------------------1�1---- DATE. Alterations and/or recommendations:-------- 4. _ -------------------------------------------------------------------------------------- ------- ---------- ----------------------------------------------------------------------------------------------•---------------- ---------I----------------------------------------------------------------- - ---------------------------------------------------------------------•--•-- -------------------------- -------- ---------------------------- -------------------------------------- ------------------------- ----------------------------- ------ --------------------------------- - ---- --------------------------------------------------------------------------- ----------- --------------------------------------- ----------- FWAL INSPECTION BY: ...... Date ------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT r'. 1401 E.Haselton Ave. 340 West Oak Street 124 Sycamore Street 205 West 9th Street Slocklon,California Lodi,California Manteca,California Tracy,California F.P.C q.