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FOR OFFICE USE: ------------------------------------ --- ------- ------ - -------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .: _f� i!a --------------- ---- ------------------------------------ (Complete in Duplicate) v — — Date Issued ---------------------------------------------------------- This Permit Expires 1 Year From Date Issued Application is hereby made to the San Joaquin L al Health District for a permit to construct nd install the work herein described. This application is mado in complian ith o Ordinance o. 549. } L/�/ f `T � � n � /� _ - . JOB ADDRESS AND L CATION Oo --------------- --- - ------ -------_"0171 Owner's Name.------ -- •- ----• ----------- --- s---------------------------------•------ Phone-----------•-•-•------•---------••-- Address------ �--4 _ 1 . i ----------------------------•---------------------•--------- Contractor's Name.-- --- --------- Phone.. Installation will serve. Residence eApartment House ❑ Commercial ❑ Trailer Court E] Motel C] Other ❑ Number of living units: J---- Number of bedrooms-7- Numf baths-_.®--- Lot size . -- ' -------------------------------- Water Supply: Public system E] Community Community system ❑ Private Depth to Water Table -------- ft. Character of soil to a depth of 3 feet �Serid-❑Gravel E] -Sandy Loam E] Clay Loam ❑ Clay Adobe ❑ Hardpan Previous Application Made: (If yes,date-------------------- No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS:• -- =r. (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest well_,- o-.____Distance from-foundation--.--14----_--..Material._._._. ------------------------- a X� --C Liquid ,No. of compartments........... _ _____ .._Siz�� r depth------.. - --Capacity-- � Dispos Field: Distance from nearest we ....___.Distance from foundation.----/-Q..._....Distance to nearest lot line .. - .- Number of lines_--------_______-------_---_-------Length of each line___--f Q_.__---_-_-.-._.Width of trench.-7---.-.----_-_--- . Type of filter material----------S_-K-------Depth of filter material------j-F_-* Total length......... --------------------- $eepa ePit: Distance to nearest well-----,.d-0.......Distance fro foundation--___�_ _------- Distance to nearest lot line__._.___.__ .• r r Number of pits---. _,X---------Lining,ma#erial_____S �_----.Size: Diameter---- - -----------Dep#n__ -t .- ---------------- 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--------------------------------------------- --•---------------------- ---------------------- -----------------------------------r----------- Remodelingand/or repairing (describe)-------------------------------------------------------------------------------------- ------------------------------------------------------------------ ---------------------------------------------------------------------------.. N --------------------------- ----------------------------------- --------------------------------- --------- ------ -- ----------------------------------------------------------------- ------------------------ ---- ----------------------------- --------------------------------•• ----- ------------------------•-- I hereby21ws t I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, Snd rules and regul s of the San Joaquin Local Health District. (Signed)--------- ----- �* =- - ---------- --- �"d/or ContractorBY� c------ ---------------------------------(Title)-------------------- ----------------------- ---- (Plot plan, showing size of lot, location of syste in relation o wells, buildings, etc., can be placed on reverse side). :FOR-DEPARTMENT USE ONLY - -�- - -� f r APPLICATION ACCEPTED BY -------- DATE r REVIEWEDBY------------------------------------------------------------------ - ---------------------------------------------- --------- DATE-------------------------------------------•--------------- - �F rBUILDING PERMIT ISSUED......-------------------------------------------------------------------- ------------------------ DATE------------------------------------ -- - --------------- Alterations - - ----- -- Alterations and/or recommendations:___---------- ---------- ' r ---------- --------------------- ------------------------------- -------- - ------------------------ --------------------------------------------------------------- --------•------------------------------------ -----•- ------------------------- - -------- ------- ----------------- AFINAL INSPECTION BY:.- e? ! ---- ------------- Date--- ---- -- ------------ ---- - - ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slockton,California Lodi, California Manteca,California Tracy,California F.P.CO.