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FOR OFFICE USE:f _�-- r� ,( �ey ____________!_ _��_ ____.- 6 IF APPLICATION FOR SANITATION PERMIT Permit No.. _... - -._._ . /�r ------ ---- -- ----------------------------------------- (Complete in Duplicate) Date issued ---------------------------_--------_-------------------- This Permit Ex ices ] 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 with Count rdinance No. 544. JOB ADDRESS AND - - - - LOCATION_ rV� F --------------••----------------------------------------------------------------------------------------------- --- - Owner's Name ---------- --------- ---- Phone------------------------------------ Address �C�----------------------------- - -- `---------------•------------------------------------------ Contractor's Name----------- ---------------- •-----•-7-•------------------------------•------ --------------- Phone................................... Installation will serve: Residence [&/fCpartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---I---- Number of bedrooms___ Number of baths _/----- Lot size ---7S----X-/_,S_________________ --------------- Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table 90 ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Hardpan ❑ Previous Application Made: (If yes,date.-------------------) No [/ New Construction: Yes ❑ No FHA/VA: Yes ❑ No E—, TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept�a� Distance from nearest well________________Distance from foundation--------------------MateriaS-----------.------.._________-_-_--_-__.________- No. of compartments----- ------- ----- ----Size------------------ -------------Liquid depth---------- ---------------Capacity----------------------- Disposal.Fie l � Distance from nearest well.-,.- Distance from foundation./o..`__.._._-..Distance to nearest lot line__sti7!...... 1K Number of lines___._I-------_----------_ Length of each line_.3__Q----------------...__Width of trench--..1__y.-___..___.________. Type of filter materia Q_C _Depth of filter material-_41--11_______.___Total length___-So-'_________ _________________ \ Seepag Pit: Distance to nearest well------ ____ ______Distance from foundation----f p_____i____.Distance to nearest lot lines._________ Number of pits----I-----------------Lining material__ 4- Size: Diameter---!�3__3__' Depth__---.�_ ________________ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-----__-____---_-__----_.-___._______ Size: Diameter--------------------- ---------------De th-.------------ ---.----Liquid Capacity-.-. Privy: Distance from nearest well--.-- --- -------------_------___----__Distance from nearest building------------------------------------------ F1Distance to nearest lot line--------------------------------------------- -------------------------------------------------- -------------------------------------------- Remodeling and/or repairing (describe}-------------------- ------------------------------------------------------------------------------•---•-----------------------•------------------------ ------------------------------------ ----------------•------------------------------------------------------------------------------------------------------------------------------------------------------- --------------- I hereby certify that I have pr pa this application qnd that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and egul i ns of e n Joa uin Local Health District. (Signed)--------------------------------------- a ------- --------------- ------ ---------=--------------- --------(Owner and/or Contractor) 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-------- � ��- W ------------------------- ------ - - - - - - REVIEWEDBY------------------------------------- - ----------------------------- DATE-- ------------------------------------------------•-------- BUILDINGPERMIT ISSUED-------------------------------------------------------------–-------------------------------------- DATE--------------------------------------- - -- -- ------ ----- Alterations and/or reyommendations--------------------- ---------------------------------------------------------------------•-------•----•------------------------------------------------------ fJ' D ------------- ------------------- --------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------ - ----•---- --------------------------------------------------------------------------------------------------------------------------------------------------------•-------- ----------------- - ----------------- --------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------ FINAL INSPECTION BY:...._._..--._--ld - Date--------- .&-:-y_- '--rO-------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Sfeckton,California Lodi,California Manteca,California Tracy,California F.P.CC.