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FOR OFFICE USE: It={ - t. V, ---- ------ APPLICATION 'FOR SANITATION PERMIT Permit No. f � =- ------ --------------------------- ----------------------------- (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 applica Iion,is made in compliance with County Ordinance No. 549. JOB,ADDRESS AND LOCATION_______ -- -------- ��------------------•---------------------------- Owt�er's Name -------------------- Phone - •• � ------ -------------------------------- -----------------------------------. Address- �a--------------•-•------••----- -------- ----- --------------•---y----l-o---!------~--�--/-------2-�•-------- r -----------Contractor s' Name - Phone l� Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer. C .urt ❑ Motel ❑ Other 0'' 4410 Number of living units: -------- Number of bedrooms -------- Number of hath---_.__ Lot size ------- ------------____________ Water Supply: Public system 2"" Community system ❑ Private ❑ Depth to Water Table 5_.'o ft_'. .r . Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ AdobeX 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.) c- f• � Septic Tank: Distance from nearest well____Distance from foundation_14____------- .Material_F --- -----_---------------_--------- ____ ®� No. of compartments---------------------Size__3x�X_9----------__Liquid depth-----L_ _--------------.Capacity---9�_�--- T* Disposal ield: Distance from nearest well 'en _Distance from foundation._l�_" Distance to nearest lot line__S.__--.___ L� Number of lines------ _____ Length of each line---yl�_�.________ ._. _____Width of trench_ _a `V . __�--_.._______ Type of finer material__J��_ :c_�'__Depth of filter material__ �__f�_____--Total length_____________��_--- ____-________ Seepage Pit: Distance to nearestwell_--_Distancig-#r m foundation__Zo__�-------Distance to nearest lot line__ l.____ Number of pits----- --------------Lining material / �...Size: Diameter-___--33-....__......Depth--------------------------------- Cesspool: ____ _ -_Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------------------- --4. El Size: Diameter-------------- -- ------- ----------Depth------ --------------------------------------------Liquid Capacity --•-- gals. Privy: Distance from nearest well---------------------------------------------____Distance from nearesf building_______------.__________-________.______- ❑ Distance to nearest lot line----------------------------- --- - --- ------ --------------------------------------------------------------- Remocleling and/or repairing (describe):-------- - ------ -------------------- -------------- ----------•----------••----------------------------------------_----------------------------------- ---------------------------------------------------------------------------------------------------------•--------- -------------------------------------------------------------------------------------------------------- ;..r ------------------------ ----------- - ---------------------•----------------------------------------------------------------------------------------------------------------- ------------------- --- -- -- ............ I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance$,'S to laws, and rules and regula ions of the San .Joaquin Local Health District. (Signed)-------------------------- ----- ------------------------------- ------------------------ -- ------ -----------------------------------------------------(Owner and/or Contractor)j bY: _ 7nt -•` -----------------------{Ti+le)- �* ----- ------ (Plot plan, showing size of lot, location of system in relatells, buildings, etc., can be placed o reverse side). FOR DEPARTMENT USE ONLY r APPLICATION ACCEPTED BY - ---- �`' — DA7E `� ` - ------------ --- -- REVIEWEDBY------- --------------------------------- --------------- - -- ----------------------- ------------------------------ DATE------------ - BUILDING PERMIT ISSUED-------------------- - TE Alterations and/or recommendations:---- r.---. -----•----- ----------------------------------------------------------------------------------------------------------------------------------------------------- --•---------------- --------------------------------------------------- -------------------------------------------------------•-- ------------ ------ ----------------------------------------------------------------------------------- ------------- ------------------------- ,. f FINAL INSPECTION BY:-----------.. -------- :--- Date SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocklon,California Lodi,California Manteca,California Tracy,California �.. -- F.R.0 C. fF,