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FOR OFFICE USE- - � } APPLICATION FOR SANITATION PERMIT Permit No. . _- .. ---------------- --------- - - (Complete in Duplicate) - Date Issued ---------------------_---------____-----------_____________ This Permit Expires Year From Date Issued` ,¢p 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. 4o%� � y / JOB ADDRESS AND LOC INI Q�(J�O D,1ddf/3 /'a. `.A°��a /� -mac t '1 �-------- Owner's Name -••---� �' ----------------------- Phone_* � _.�.71� �'f Address-----------------------------------a l f /Y - ------------------------------------------------------ Phone.1.6� -f Contractor's Name / ✓l l f�--- ' - ----------------------------------------------- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other [] Number of living units: __1---!1MlNumber of bedrooms __ _ Number of baths __f___ Lot size -------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table-------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E&/Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date__________________ ) No [jK New Construction: Yes eNo ❑ FHA/VA: Yes [...No .,i TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspoolpermitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest weI{---0------ Distance from foundation___ _________._____._.___. i No. of,compa tmenfs-_-.----__.'.+L______-Size__4/,X- '_:9------Liquid depth__.__c"� �r.`�___._Capacity__ Disposa field: Distance from nearest well_____ .Distance from foundation_f�__ ..__.Distance to nearest lot line____ -___ Width 'J �, Number of {fines-__-______�_______ ______________Length of each line_____�D_�_�___-__- dth of trench.__,�rZ�:__-____________._-'" Type of filter material__ /Q�K�_:Depth of filter material ---------Total length__--- 9-��-- -----------------------± I Seepag it: Distance to nearest well._/P�_ _.. --------- Distance to nearest lot line___'__ :I' is fr foundation__ EV Number of its___-__ ---Linin material__5/,%ft Size: Diameter.__ _ --~'. _ -Depth.... Cesspool: Distance from'nearest well- -------------Distance from foundation------------------- Lining material--------- ---------- ------------------ I El Size: Diameter-11----------`-------------------------Depth---- ------------------ --- ------ ---------------Liquid Capacity tgalls� Privy: Distance from ,nearest well------------------------------------------ -- - -Distance from nearest building._.-____.-___.______________.___- l ❑ Distance-to nearest lot line'.��r --�---�--------------------------------------------- -•-••- ----------- ----------------------------------••-•-------------------� Remodeling and/or repairing (clesC1-ribe):- A&It / -- -- - -- ----- 1 - ------------------y----------------------- ----------------------------------------------- --- SIM ------------------------------------ -�M ------ ---------------------------------------------- ---------------------------------- ------------------------------------------------------------I, 1 hereby certify that I have prepared this application and that the work will be'done in accordance with San Joaquin County ordinances, State laws, a rules a d regulations of the San Joaquin Local Health District. (Signed)------------------- j (-�fy- --- ----- ,1^ I- ._. = a-: /na /or Contractor) By:------------------- - ____Title) (Plot plan, showing six lot, location of tem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-- -- ix ----- -- --- ----------------- ----------------------------------------- DATE------ - ------------- REVIEWEDBY---------------------------------�N: ------------------------------------------------------ DATE---------- ------------ BUILDING PERMIT ISSUED---•------ SIM.. --------------------------- ------------------------------------ DATE------------------------------------- Alterations and/or recommendatio"n"s------------- ------------------- ------------------------•-----•-----•--•------------------------------------------------------------ -.y `��`'< j----------- �-�-------------- -- ----------••---•---•------------------•-------------------------------- -------- -------- ---------- -------'ar sf.:.l�s =-�M'-=-r' e - - J� . t ----- -------------------------------I--------------------------------- ----------------------•------ ------ - ---------- ----- ----------------------------------------------------------- ------------------------------------------------------------- --------------- -------------- --------------------------------------- --------------------------------------- - 1l------------- --- --------- ---------- ------------------------- ----------- ------------------------------------------- -------------------------------- rr FINAL INSPECTION BY: Date--------'�:n f=C<. .� SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazellon Avg. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Slocklon,California . Lodi,California Manteca,California Tracy,California F.RC O. -Il