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FOR OFFICE USE: 'I sE�a ----------- -�----� i9-- ---��---��--------�----� - APPLICATION FOR SANITATION PERMIT Permit No_ ______________________ -------------------___............. (Complete-in Duplicate) ��. .......... This permit Ex fres 1 Year From Date Issued P, r 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 No. 549. 6L-T3 --67o .-01w % - 1 JOB ADDRESS AND OCATION - .��,/ C - vt�. --.- --- __ - Owner's Name----------- __t__ -r----- -- -- -- ----- - Phone---.--------------------••- -----. i --Q Address . --- . ..... .�fr "..31 ..' . �+ --------- Contractor's Name--- �_... ...4+!,.. ----- Phone------ --------•--------- - Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ E Number of living units-/---- Number of bedrooms Number Number of baths.____... Lot size ..... ... ........ ........ ..................._-.-.__.-.. '� I Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ...... . ft I Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑u Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan [ J .Previous Application Made: (If yes,date-....... .......... ) No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: II (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic nk: Distance from nearest Distance from foundafion....!p. __..Material ____ _____________ ___............-_---_----_-. No. of compartments------- ___Size3.11!__g. __ IS--Liquid depth___._______ ___-___Capacity..,?'- 0:is Field: Distance from nearest well____.J�P___-_Distance from foundation----1-42...........Distance to nearest lot line_✓'...------- i� Number of lines----------1---------------------Length of each line-. .fvip--------------------Width of trench___. ------------------ --------- Type of filter material--------- --Depth of filter material--_..�Q. ...Total length-----4.1d.1----------------------------- Seepa Pit: Distance to nearest well.__-_.l00 -Distance from foundation----/__P_._ .__..Distance to nearest lot line-:___S ____________ Number of pits--- ---------/-------Lining material.-.---4.41 ..__ Size: Diameter-----,�3...._._.___Deptn---2"-_-r--------------------- Cesspool: Distance from nearest well . Distance from foundation................. . Lining material------------------------------------- 14 ❑ Size: Diameter. epth--------------------------------------------------Liquid Capacity-------------------------------gals. Privy: Distance from clearest well.------------------------ -------- -.......-.Distance from nearest building.-.-__-_-_-___._.___-_____. Distance to nearest lot line ------- .......................-- ----------------------------------- ------------------------------------------------------------ ^t Remodeling a+ (describe):.......... --- i a - --------•-----------------------------------------------------------•----------------------------------------------------------------------------------------------------------------•-•------------------------..._--- -------------- ---- 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, i (Signed)---.--- . - and/or Contractor) I----------------- ----------------- By. - --------------------- ---------------------------------------(Title)------'--- ------ ... . (Piot i plan, showing size of lot, location of sys m in relation to wells, buildings, etc., can be placed on reverse side). } FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY- --------------------------------------------- DATE---- --------------------------- REVIEWEDBY------------------------- -- - ---------- ------------------------•- DATE---- - ----------------------------------------------------- B.UILDING PERMIT ISSUED-------- -- ----------------------------------------------------------------------------------------- DATE------------------------------- Alterations and/or recommendations:.------- ----------------------------- - ---- ------------------------------------------ -------- --------------------------------•---------------------- ------------------------------------- ------------------------------------------------•---- ------------------ ----• --- ---- ---------------------------------------------------------------------------------------- ----------------------------------- -------- ------ ------ ----------- --------- --------- ------------------------------------------------ ------------------------------------------_-------- ------------------------------------------- f FINAL INSPECTION BY:..r ��'�� '��t ------------- Date .rl. � _.. r. - ......... ..... SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:*llon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Sfocktan,California Lodi, California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard press a