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FOR OFFICE USE; ---- -------------------------------------------------- mi�l. ----- _-- ------------------- APPLICATION FOR SANITATION PERMIT Permit No. .rrlf�, ------ (Complete•in Duplicate) -- This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District fora permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549. ,E Al 1401 JOB ADDRESS AND LOCATION_ 7yy1 - �� r ------------ ---------------------------- 00. r �� Owners Name--:=.4n ?rl.._-`_: ---- ----- ------ -- --------------------- --- - ----- -------- Phone------------------- Address------- ". ; _ i - - Contractor's Name__ . ? - `--,-------------------- Phone------ ----• ------------------ Installation will serve: Residence 0 Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J------Number of bedrooms __''ri-. Number of baths _1_.._ Lot size ___ -------- -�_____.._____._______-._.-_.._ _ Water Supply: Public system ❑ Community system ❑ Private ❑ Depth to Water Table ------ - ft W Character of soil to a depth of 3 feet Sand ❑ Gravel [] Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ N Previous Application Made: (If yes,date------------- } No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: j`(i (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . �. Sept Tank: Distance from nearest Ih o. .- Distca fro oundation__l. -'_-____...Material -- -/?' i lo. of compartments_____--__----_..___._.__Size_ ____�-"__ _____ -_-.____Li uid de th____._-y_____. .- q p Capacity � ' Disposal Field: Distance from nearest well.,C0-.2+'......Distance from foundation__./O-`..__.._Distance to nearest lot line_,-t------ �i Number of lines ._.__l_________________ Length of each line__/_"_._.---- ---_Width of trench___-�.1�_-------- --------- Type of filter material_ ....... Depth"of filter material .--Total length_P qD ___________________-______ S-5-6'page`Pit: Distance to nearest well_,/ __rt----Distance from ounclation_.irb_ _.____- [Distance to nearest lot line_-�d____..._ Number of pits-_d2---------------Lining material._ '____-- Size: Dibmeter_..1�1?------- ----Depth_. :�,$el -______.___---__._ 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 __i ----------------- ---------------------------------------------------------------------------•-------------- - - -------------------- Remodeling and/or repairing (describe)---------- --------- -- --------- ----------- ------- ----------------------------------------------------------------------•---••---------------------------------------------------------------------------------------------- ------------------------------- ! I hereby certify that 1 have prepared this application and that the work will 6e done in accordance.with San Joaquin County �I ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. d (Si ned z ,.ss,: :. 9 ) ---- M:-------,-------------- --------------- -------------------------------- ------------------- --- Owner and/or Contractor) By% �r; � f+cit- ---- - --- -------- ---------------------- ----- _ - ----f-- - ----- ••-.-----h-- - - --- -� _-- - --(Title) __��`':��'� - (Plot plan,{sho .rng 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- astal ' = ------------------------------------------ ------ DATE--,?--- ------------------ . REVIEWEDBY----------------------------- ---- ._-------------------------------------------•- -- -----•-------------- --•--. DATE........ 1 BUILDING PERMIT ISSUED ----------------------------- --------- DATE. Alterations and/or recommendations:----------------- ---------_---- --- --------------------------------------------- ------ -------------------- . -------- ----------------------------- --- -------------------------------------- -•------ ................. �a FINAL INSPECTION _ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave._ 300 West Oak Street 124 Sycamore Street 205 West 91h Street Slocklon,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard Press ,—