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FOR OFFICE USE: r� --- --------------- -------- k APPLICATION FOR SANITATION PERMIT Permit No. 69426_ --------- --------------------------- ---o--------------------------- ------- -- -- ------- (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 in compliance with County Ordinance No. 549. JOB ADDRESS AND LOCATION--- ___.____------- ------------------------------------ Owner's Name------ ------ -.014- --- --------- Phone-----------•--------------------••-- Address----------..-bl,_JIA�------ -----------6 -- -----•------------------------------------ Contractor's NamL� n - .____ Phone----------------------------------- - ------------------------------ Installation-willserve: Residence Apartment House ❑ Commercial [] Trailer Court ❑ Motel ❑ Other p Number of living units: __: ___ Number of bedrooms 3-___ Number of baths _./--_ Lot size _______________._.._____--_-._________-__-_____-____-__.._ wWater Supply: Public system Community system ❑ Private ❑ Depth to Water Tablel�_S`ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sa dy Loam E] Clay Loam E] Clay E] Adobe 29—Hardpan ❑ Previous Application Made: (If yes,date-----------_------__1 No M7New Construction: Yes yr'No ❑ FHA/.VA: Xps M No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well__'_—__-..__Distance from foundation-h ---------------Material----___r__..-.-_..__.__-__.___...._.-.__--___-. No. of compartments----- Size-------- _____Liquid de th__-_. f __.Ca acit Disposal Field: Distance from nearest well.....—.---- Distance from fo ndationZO----______._.Distance to nearest lot line__' -_`-._. Number of lines___ _____________________Length of each line---------------.-----------...Width of ----------- Type Type of filter material';i12_��___-_Depth of filter material__1_ '_ ._--.-.Total length-----Zf: ---_________________ \1 Seepage Pit: Distance to nearest'-well--- Distance ram foundation____Q--------- Distance to nearest lot line__Q5----f--_ Number of pits____? ...............Lining materia_---KV It Size:•DiameterA33__.`'_.__.___-Depth___-;?1-"__i___-__-._____._. � 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-------------------------------------- ------------------- -------- Remodelingand/or repairing (describe): -------------------------------------------------------------------------------------------•------------------------------------------------------- -------------•-------------------------------- ------ ------•-------- •---------------- - -- ----------------------------------------•--•----------------------------------------------------------.._- i ------------------------------------------------------------------'----------------------------------------- ------------------------------ ----------------------------------------------------------------. ..----- I hereby certify that I have prepared this applicatio and that the work will be done in accordance with San Joaquin County ..�; ordinances, State laws,,jind rules and regulations oft a San Joaquin Local Health District. (Signed)--------------- -' - - ------------------------• •------------- --•--------------------------------------------)Owner and/or Contractor) 4 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 DATE Alterations and/or recommendations---------------- ----------------------•---------------------------.-------.------------- -------------------------------------- ----- ------- -------------- ------ --------------------------------------------------------- ---------------- ------------- -- ---------•------------ ---------------- ---------------------------- ----------------------------- --------- ----------------------------------------------------------------------------------------------------------------------------------------------I------- FINAL INSPECTION BY:...--- ------ ----- Date--------------- ---------------- -------- ------ I SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slockton,California Lodi,California Mantecar California Tracy,California F.P.CC.