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FOR OFFICE USE: _________________ ---------------- -------- ___.._____._. APPLICATION FOR SANITATION PERMIT Permit No. -...- [Complete in Duplicate) ' ._- _ __ ________--------_____ Date Issued _______'z_.._.__. This Permit Expires I Year From 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 wit Co my Ordinance No. 549. JOB ADDRESS A CATION_ ------- Age e ? ------------------------------------------------------- Owner's /__ C7S Owner's Name----- ..... Phone------------- Address------------------ --=--- - Contractor's Name--- ---------- ------- - - -- ---••------------------------------------- - -------------------------------•------------- Phone----------------------------------- Installation will server Residence gq'7�p_artment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: --/-- Number of bedrooms S.- Number of baths __`_ Lot size _-._ Water Supply: Public system lk�_C'ommunity system ❑ Private ❑ Depth to Water Table&�:ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 9j,- Trdpan ❑ Previous Application Made: Ilf�yes,date-------_____________1 No &--`IVew Construction:- Yes 991-I10 L] FHA/VA: Yes 9;,No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Septic Tank: Distance from nearest well__— _ ______Distance fr m foundation --- lsf__-----.Mate . _---------- ®� No. of compartments..-_ ---_-_-----_Size_ - ____,-_-Liquid depth__.�� . ---------Capacity_ ........ Disposal Field: Distance from nearest ail____- ,.--,Distance from foundation__ s �'1 --___----Distance to nearest lot line Len. th,o$ each line__: ._ "� � Number�.of..lines______-- g -y- - Width of trench__a_�-------------------•- } Type of filter materia /I�� Depth o `filter material___ _____.._ Total length„�� _________________________ Seepage Pit: Distance to nearest well------*-.-------Distance fr fou ation___/AO.•.__ Distance to nearest lot line.-._____ -� Number of its - ”- r� �- p �r__._____-.Lining material__- _---Size: Diameter-- _.Depth_/�� 11------------------ Cesspool: Distance from nearest well_________________Distance from foundation-_.._._.....____-__ Lining material______..____.._______.___.___`- ❑ Si ,zeDiameter -------------------Depth---------------------------------- -----------------Liquid Capacity- --------------------- ga Privy: Distance from nearest well_______________ ________________________________Distance from nearest building-----_---------------------------------- ❑ Distance to nearest lot line - --------------- ----------------------------- l 01 Remodeling and/or repairing (describe}:- „/ �___-- -- ' -------------------•------------- ------ ---------------------------------------------------------------------------------------------- ---- -----------f------------------------------------------------------------------- [�C i 1 hereby certify that l have prepared This application-and that the work will.be done.,in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the San Joaquin Local Health District. d (Signe )-------------- -------- - . -- - •------`'r _� -------- - ------- - --- -----------------------------------------( Contractor( By:----------------------------------•------------------------------ ------------ - ----�G (Title) ---., (Plot plan, showing size of lot, location of system in rel n to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------- '----- -------------- -- ---------------------------------------- DATE------- REVIEWEDBY-------------------------- -------- ----- -------- ---------------- ------- ---------------------------- --------- DATE----- - - --------------------- L1ILDING PERMIT ISSUED---------------------------------------------------------------------------------._.----------------- DATE----- ---- -- -------- terations and/or'recommendations-------------------------- ----- -------------------------------------------------- --------------------------------------- ------------------------- ----------------------------------------------- ---------------------------------------------------------------------------------------------------------- --------------- -- -------- ---------------------------------------- FINAL INSPECTION BY: = ---------- --- ------ Date-------------------------- „ rt SAN JOAQUIN_ LOCAL HEALTH DISTRICT i 1601 E.Hazelton Ave. 300 West Oak Street R 124 Sycamore Street 205 West 9Th Street Stockfan,California Lodi,California Manteca,California Tracy,California - P.P-CC. �+- .