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FO FF E USE: it ---------------- ----------- -- �! - APPLICATION FOR SANITATION PERMIT Permit No. /7`11�! . ------ (Complete in Duplicate) Date Issued _�:`_��'_� :_� ----------_ 1� This Permit Expires 1 Year From Date Issued Application is hereby made tote 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. JOBADDRESS AN OCATION---------� ----------------------------------------------------- ---------------------------------------------------------_-------- Owner's Name------- - --------?/-------------------------•-------------- -------------- Phone------------------------------- Address-------------- -------//---T!_-f--e-- ------------------------------------------------------•---------------------------------------------------------------•----------------------••------ Contractor's Name------ --^ -------------------------------- ------------------------------------------------------------- Phone..--------••---- -- Installation will serve: Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑ +Motel ❑ Other ❑ Number of living units: __/-__ Number of bedrooms _je� Number of baths /-__ Lot size/i -t`�_ ___________________ Water Supply: Pubiic system [Community system ❑ Private [–] Depth to Water Table CQ✓ft ' Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 2--lHardpan ❑ Previous Application Made: (If yes,date--------------------I No 9j" New Construction: Yes Z3r'No ❑ FHA/VA: Yes P9---No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: ' (No septic tank or cesspool permitted if public sewer is available within 200 feet.) . . Septic Tank: Distance from nearest well___".-_--__Distance/f om If/oundation_. /� Matelal_-,& �''------------------------ "I p .fir? X T.p� q i l ep, y, No. of compartments____ _______________Size____. ._-- _____ ___Liquid de th__ ._----------Capacity__ ------- Disposal _____Dis osal Field: Distance from nearest well.__..–--------Distance from foundatio __ -- ------- Distance to nearest lot line__--- .___.-_ Number of iines._______f_.._.�__. �r -___._ Length of each line_____/�`__ _ -------Width of trench-_,x _________________________ Type of filter material_ �--Depth of filter material_._A4_.__--------._Total length--_� ------------------------------ rrnn ` vl Seepage 1t: Distance to nearest well____-.—.-------Distance f om fo ndation___��____._.Dist`nce to nearest lot je- ---�--.- Number of its----_Z ----------Linin materia!_ -_.a �� � p g � Size: Diamete�t�_____________ r 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------------------------------------ ------ ------ --------------------------------------------------------- Remodeling and/or repairing (describe):--- - - ------ --------------------------------------------------------------- V ---------------------•------------------------------------------------------------------------------------------------------------------------------------------------------------------------•-------- --------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------•------------------------------------------------------------ I -----------------------------------------------I hereby certify that I 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. (Signed)-•---------------- - - -- - -------- -------- ---- ---- ------------ -- -------------------------------------------- or Contractor) ___Title (Plot plan, showing size of lot, location of system in a tion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY------------ ------------------------------------------------------------ DATE.-------= T -------'- -- ------------------ REVIEWED BY--- --- --- ------------------- -------------------------------------- DATE BUILDING PERMIT ISSUED a - DATE Alterations and/or reco mendations:____' _ -.- _ _ ` _-__ . -___ . _ _ -- �., --- -------•------ -.-. a-- ----------- ------------------ --- -- --� - =-------•--------------- - ---- -- ------ ----- � -------------- FINAL INSPECTION BY------------------------"---------------------------------------- Date--------�f f`s ------------- ----------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:eilon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Slocklon,California Lodi,California Manteca,California Tracy,California E5 9 REVISED 9-59 3M 3-'63 F.P.C13.