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I FOR OFFICE USE: `= = -----------3.2-`'- APPLICATION FOR- SANITATION PERMIT Permit No:=: � s - ---------------- --- --"--- -- ---------------- (Complete .in Duplicate) Date Issued -------------------------------------------------------- This Permit Expires I Year From Date Issued C Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. k This application is made in compliance with County Ordinance No. 544. JOB ADDRESS AND LOCATION------------ ------ ------ ---------------------------- Owner's Name----------,l ",1 ----------- - ----- ---------- - - -------------------------------------- Phone------------------------------------ ----------•-------------•-------------•--------------------------•-------------•--.-- - ------------ Address-----...--�-�-----1+�---1----------- -} -------- --- ------------------�-- ,. Contractor's Name--------------->�-- -- -- ------ - •------ Phone_ �_• _aG� Installation will serve: Residence Apartment House Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _ _-- Number of bedrooms __`'Number of baths __/_ Lot size ------ ----1-Jor-------------- ----- I Water Supply: Public system Community system ❑ Private ❑ Depth to Water Table -------- 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 lk New Construction: Yes ❑ No FHA/VA: Yes ❑ No TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet-) t Septic Tank: Distance from nearest well-----------------Distance from foundation-----------------------Material-------------------.-_-_---------_--_-__.____---.. ❑ No. of compartments--------------------------Size--------------------------------Liquid depth----------------i;--------.Capacity----------------------- Disposa F• Id: Distance from nearest we]..��__.___Distance from foundation---1D-.......Distance,to nearest lot.line.___&:_-�_.. Number of lines______________ ______ Length of each line_-_._____.4��:._''___._Width of trench---------ZS!��_________.____ Type of filter materia Depth of filter material-__f _/��__.._.__Total length_-_--_-SCQ-�_________________________ !� Distance to nearest lot Seepage Pit: Distance to nearest well_. ---0_�-_.__Distance fro fo dation__ _______________. xNumber of pits.-._---------_-lining material___ ._Size: Diameter____J,.7-"'"Depth-------c;t5�------------- Cesspool: Distance from nearest well-_____________.__Distance from foundation_---------------- Lining material---------..--------------------------- 1 ---_-------------Li Liquid Capacity 1 ❑ Size: Diameter--------------------------------------Depth- ---- -- --------- -------�_ q P Y----------------------------gals. , Priv Distance from nearest well______________________ .Distance from nearest buildingI ❑ Distance to nearest lot 1ine------------------------------------------- --------------------------- =-------------------------------------------------------------------- i Remodeling and/or repairing (describe):-- -------------------------------------------------------------------------------------------------------------- ------ ----------------------------------------------------------------------------••----------------------------------------------------------------------------------------------------------=----------------------------------- ------------- ---------------------------------------------- ----------------•---------------------------------------------------------- - ------- - ------ ----------------------- 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)•------------t----r--------- --- �` `' t (Owner and/or Contractor) BY- --- -------------------------------------------- r-.{Title) -- ----- ..._......._._.._.. I (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). # _ .4 FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY___________ ------------------------------- DATE____15' _____________ ( REVIEWEDBY-------------------------- ----------------- ---------- - --------------------------------------- --------------- • DATE - BUILDING PERMIT ISSUED---------------- fes, -------------- ------------- ------------- DATE-------------------------- --------------------------- Alterations and/or recommendations:---- . ---- ------- --------------------------------------------------------------------------------------------------------------------------------------------------- •----------------------------•-- -----•----------------------=------ ------------------------------------------------------------------------------ ---------------------- ------------------------------------------------- --------- ---------------------- FINAL INSPECTION BY:-._._.__--�� ------- Date__._- ----------------------------------------------------- SAN --G-}SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 4th Street r I Stocklon,California Lodi,California Manteca,California Tracy,California F.P.CO.