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FOR OFFICE USE: ---------------ry ---- APPLICATION FOR SANITATION PERMIT Permit No. .. G ... --------------------------------------------------------- (Complete in Duplicate) Date Issued _._....................................................... �-This Permit Expires 1 Year From Date Issued Applica+ion 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 wit County inance 549 1. - -�-- JOB ADDRESSID LOC ION__ '`� �- Owner's Name___ __ _ _ _____ Phone_'_f-_-!©______ _ 4-111.4.,u- f rr Address. j" -- � � �� '. ------ ------------ Contractor's Name—_��'1.It.�- IL Phone. ...- - ------------------------------------ ` Installation will serve: Residence &"<partment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/----- Number of bedrooms2___ Number of baths ---- Lot size - ------------------------------------------ --- r -/--�---- ---•---•--------------------- - -- Water Supply: Public system E] Community system ❑ Private F1 Depth to Water Table 60 ft. � Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe 8-'-Hardpan ❑ Previous Application Made: (if yes,date--------------------I No ❑ New Construction: Yes ❑ No Rl'�FHA/VA: Yes f No ❑ :9 TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sep�fic Tank: Distance from nearest well_A&A.1_Distance fro fon tion._ _�f___.-_Material. :OCL No. of compartments_ Size f7 %Q Liquid depth___. -�--___._Capacity-------�00 �1 Disposal Field: Distance from nearest well.6011-4...Distance from foundation__!-67-----Distance to nearest lot line_ �,Ai�J Number of lines.__,___._ ____.___ ___ _ ____Length of each Iine,5_0�_____`--____..Width of trench.._-----_____._r________ ,f Lf Type of filter material Depth of filter material-----1-9_ _______Total length____________________ --------------- JA l"/ Seepage Pit: Distance to Weare well.- t?1'L.>e-----Distancne from foundation____----------.Distance to nearest lot line__,.')______.__ 1 Number of pits... Lining material_I-d-d ______Size: Diameter.__,3� p f ' Cesspool: Distance from nearest well g { _Distance from oundation____________________Linin material_____.-______-____..____.____.___.___. L�1 ❑ Size: Diameter--------- --------------- - -- Depth-------------------------- -- ------- --------------Liquid Capacity----•----------------------gals. S Privy: Distance from nearest well------------------------------------------------- from nearest building---------------------------------------- X ❑ Distance to nearest lot line------ ------- ------ ----------- --------- ------------------------- ------ - ------------------------------------------------------------- Remodeling and/or repairing (describe):----------- -- --- -------- t ------ ------ -------- t -------• D ----------= ------------------------------- --- --------- ---- - - -` -------- - --------------- �--o y y I hereby certify, t at 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. 9 (Signed)•- _ , [ + ,---- -- ----- --- - ------------------------------------( ontractor) By: ----•--—`---- ------ Title) - ....... (Plot plan, showing size of lot, location of�system in relation to wells uildings, etc., can be placed on reverse side). i } FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY------- 90 -/ -------- / ------- ---------------- DATE--------- eIzjrlo `- ----------------- REVIEWEDBY------------------------ -------------- - --------- --------------------------------------------------------------------- DATE----------------- ------- BUILDING PERMIT ISSUED---------------------------------- --------------.-------- ------------------------- ------ ---------- DATE------------------ Alterations and/or recommendations:---------------------------------------------------•----------- -------------------------------------------------------------•------------------------------- ------------------------------------------------------------------------------------------------------------------------------------ ------------------------------- --------- ------------------------------------------- ----------------- --------------------------------------------- -------- -- ------ ------------------------------------------------ FINAL INSPECTION BY: - ------ - ------- -- Date--- -rJ��- L_ --------------------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street 5focktan,California Lodi,California Manteca,California Tracyr California F.P.c o.