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FOR OFFICE USE: ______________________ __________________________________ APPLICATION FOR SANITATION PERMIT Permit No. _ _�,�— ----------------------------- --- ---------------- (Complete in Duplicate) Date Issued --------- This Permit Expires 1 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 County Ordinance N JOB ADDRESS AND LO ATION...... .... .... Y / Q Owner's Name-------------- Z----------------------------------------------------------------------- f._.�!__---- ----- ! --------------- - - ----------------- ------ Phone. -------•----------------------- - ----------------- - Address-.-_..-.-..-.---------- ------- - -----. - ---------------------------------------•--------------•------_... r-_. Contractor's Name..-- -- ,r--�e------- / /, r.✓. --F. Phone./`' Installation will serve: Residence P-Apartment House ❑ Commercial ❑ Trailer Court p Motel ❑ Other ❑ Number of living units: _.. ._ Number of bedrooms ---/_ Number of baths ---4- Lot size ---A5X-._..- _-.-..--.---- Water Supply: Public system 0--t-lommunity system ❑ Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam E5-"Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date-------- -) No C3- New Construction: Yes ❑ No [;]— FHA/VA: Yes ❑ No [9— TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) f Sep :':-: Septic Tank: Distance from nearest well_.-.rr .....Distance from foundation---fa-..-----Materia __ 4&_A-5.7- _ ---------------- -- 01/ No, of compartments...-. .--2- - --------Size---CO�_ ---<--._Liquid depth___. �K.-'_.......Capacity.. ._�� Disposal Field: Distance from nearest well....... ........Distance from foundation...el .........._ Distance to nearest lot I _ . , line__. Number of lines-...__._- ---- - -------Length of each Iine.I�e�7e `.Width of trench-- -- ---.r---.-.- TYpe or filter material...-- - G Depth of filter 6..........Total length----- �-..-.-----__--------- 5eepage Pit: Distance to nearest well-----r-- ------Distancefro foundation--._!-rl-_ .....Distance to nearest lot line...`----._ `dumber of pits--.._____ - - ..Lning material--i f .Size: Diameter.. �.- '_------Deph--�.�. -_-----.---- Cesspool: Distance from nearest well--------------_-Distance from foundation------------------..Lining material----------------_.__--------------- ❑ Size: Diameter----- --------------- ---------------Dept h----------------------------------------------------Liquid Capacity- ------------------------gals. Privy: Distance from nearest well.--- ----- --------- ---- __Distance from nearest building------------.---.-_---------------------- ❑ Distance to nearest lot line- ---------- ----- -------------------------------------- -------------------------------------------------------- Remodeling and/or repairing (describe):-.... r--------P141-------- ------------•--------------------------------------------------------------------------------------------------------------------------------•----- ---- -------------------- ---------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------------------------------------------------------------------------------------------------------------------------------------------"----------------------------------------------------- I hereby certify that I have pre red this application and the work will be done in accordance with San Joaquin County ordinances, State laws, and rules egulations of the n oaquin Local Health District. - Z (Signed) r/�! �.�l - --------- ---- .�. �� e- ner d/or Contractor) By. {Title} f Y --- ------------------------------------------------------------- /------------ .-------- -------- (Piot plan, showing size of lot, ! anon of system in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY---------------------- ---- --- - --------------- ---------------------------------------- DATE-------- •�� REVIEWEDBY-------------------------------- ------------ ------------------------------------------------------------------------------- DATE-----------------------•------------------------------------ BUILDING --- ------------------------------- BUILDING PERMIT ISSUED------------- --------------------------------------------------------------------------------------- DATE------ Alterations and/or recommendations:-------------------------- ----------- -------- ------------------------------------------------- ------------------------------------------------------ c ----------------------------------------------------------------------- •------ -- --------------------- ------------------------------------------------------------------------------------------------------------------ 4" -------------------"------ -------------------------------------------------------------------------•---------------------------------------------------------------------------------------------------------------------- ----------------- --------I------ --- ----------------------- ---...-------------------------------------------------------------------------------------------- -------------------- ---------------- -- - ------ ----- ------ ------------------------------------------- -------------------------------------------------------------------- ----- -------------------------- FINAL INSPECTION BY:._--- _.__."_. Date � I------------------------------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave, 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slocklon,California Lodi,California Manteca,California Tracy,California F.P.0 O.