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FOR OFFICE USE: ------------------------- __-- APPLICATION FOR SANITATION PERMIT Permit No, ........ - (Complete-in Duplicate) ------ - ---- f -- --- This Permit Ex ires 1 Year From Date Issued Date Issued ----_ /.--- !� J 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__ j __-- ------------------------------ Owner's Name.__` ---""{ Phone . ------------------- ------------ Address----... - Contractor's Name-,-0.�--- ----------------••---------•------------ ---------------------- ----------------- --------------- ------ Phone------•---••-----------•---------- Installation will serve: Residence-JE Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: I_ - Number of bedrooms Number of baths _-j-_: Lot size -.-,--- A_lI:? Water Supply. Publics stem Community system ti. PPY� Y ❑ y y ❑ Private ® Depth to Water Table 141 ft Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam jl� Clay ❑ Adobe❑ Hardpan J� I L Precious Application Made: (!f yes date------------------- ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ f TYPE OF INSTALLATION AND SPECIFICATIONS: { (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk_ distance from nearest well-----------------Distance from foundation--------------------Material .-__ ------------------------------------------- ❑ o. of compartments--------------------- ---Size-------------------- --------.--Liquid depth-- - ------- ----- Capacity----- ------------ ---- Disposal Field: Distance from nearest well.-S_9'.*....Distance from foundation--h? ---------Distance to nearest lot line---- r-_---- , ] Number of lines ------1.........t.---------------Length of each line.. ....I- -- -----------Width of french----Z-. --------------------.- Type of filter material--. _ Depth of filter material--�.q___.......----Total length----I- p- ---_--_---------------------- Seepage Pit: Distance to nearest Distance from foundation--!_A�._.-------Distance to nearest lot line__-.------___ [,+b Number of pits... -- I _-----------Lining material.--_-_ _-- --- ---- Size: Diameter--.---�7-1P--------Depth--�.1-1.----------- Cesspool: Distance from nearest well ........... ..Distance from fo dation_______.---_.---- - 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):- ------------------------- ------ ------------•----...--•----------------------------- --------------------- ------ E -------------------------------•------------ --------- --------- ...----------- -- _.-__--------------------------------•-----------------------------------...----------------------------'-------------------------•--•-----------•----------------------------..--------------------------_.------------------ t E I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, 5 e lo gland riles and regulations o��h San Joaquin Local Health District. Signe ) .�.�•• -- -------- - ------------------------ --------- - Owner and/or Contractor ( / I ( d By:------------------------------------------------------- -----------_-------- --------------------=----------------------------{Title)-------------------------------- .............. � (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). i FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY-_ - j REVIEWEDBY ------------------------------- --�-�--�---�-�-- ------------- - --- -------------- DATE------------- --------•----- ------------ ---------.----- BUILDING PERMIT ISSUED ------_-------------------- --------�-�-�- --.....-- ------------ DATE.- ---.--- --- - - ------ DANE----------------- -------- Alterations and/or recommendations-------------- -------- -- -------------___ ------------------------ ------ -------- ---------------- -------------------- ----------- ---- --- ------- -----------• - --------------- ----- • -------------------------•------ ------- ------------------ ------------•-----------------•--- ------ --- i FINAL INSPECTION Date.e.. �. .............. . ............. --= -- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 20.5 West 9th Street Slocktan,California Lodi, California Manteca,California ..Tracy,California E.H.9 2M 1.67 Vanguard Press - k