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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 No. 549. JOB ADDRESS ANr� LOCATION------4D 3-2_-- --__ - -lCrt._r ----------� Owner's Name-------1 ------ - - -•---------- --------•------------------------ -------------------------------------------- PhonesQ.--- Address-----------------9--- 7*. --- ---- ---Arc--j------`,--,-----`---••---•-----------------------------•----------------------•--- Contractor's Name-,, -- -�-- - ll- , ---------------------- Installation will serve: Residencartment House ❑ Commercial ❑ Trailer Court ❑ Motel [] Other ❑ Number of living units: __�__ Number of bedrooms aNumberZ hs � of size ____�__._e.__ _ __ ________________ Water Supply: Public system E] Community system El Private to er Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel (] Sandy Loam Clay Loam ❑ Clay ❑ dobe [❑ Hardpan ❑ Previous Application Made: (If yes,date- ................l No ❑ New Construction Yes ❑ No FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: v f (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Si� k: Distance from nearest well-----------------Distant41 XN eJromofoundation_..____________--_.Material__z------------._.____._-_______._._._._____-- /�a"� No. of compartments --Size_ " Liquid depth Capacity p � "iz 1 --------------•---- - qn� I? r ------------------- Di sak '�Id Distance from nearest well_--------Distance from foundation. L�.e-------Distance to nearest lot line-1 d_____ I _J � � Number of lines___.____ __ i.__ j _Lengthlof each line___�Q ______��__.Width of`trench__,r�r_ _____-------- ______ + �. Type of filter teriah (G/ ___Depth of filter material�___.,��_..-._-.Total length___________________lee--------- ma . d --- - --- - - Seepage Pit: Distance to nearest well_.__...t_' _ _______Distance from foundation--------------------Distance to nearest lot line_____._._._______ ❑ Number of pits------------------ ---Lining material-----. ----------------Siz6:.Diameter_r--------....(_Depth--------------------------------- (� Cesspool: Distance from nearest well________________Distance from foundation___._._._ Lining material___.-_._...____.________________..___ El Size: Diameter----- -- Delt„h------------------------------- --Liquid Capacity----------------------------gals. Privy: Distance from earest well--------------------------- from nearest building--------------.______________________.__. ❑ Distance fo"nearest lot line---------- ------ ------------- ----- --------------------- ., �..� . =:F------------------------------------------------ Remodeling and/or repairing (describe)-------- ------- ---- - ------- ------------------------------ ----------------------- -------------------------------------------------------- --------------•-----•-•------------------------------------------------------------------- ------- ---- - ------ ----------� --- -- -- --------------------------- ---------- -- ------- --- ---------- ---------------- -------------------------------------------------------------- --- -•------•-- - - --- -------•----------------------------------- I hereby certify that ! ave prepared this application'i3rid'Alf-thi work-will be, ne in accordance with San Joaquin County ordinances, State law an rules and regulations of he San'Joaquin Local alth,District. 1 (Signed)O -7JV - ---------------------- Contractor) TI+By•----------------------- ---••-•----------------------------------------- ------- -- - -ate►- -------( ile)---------- ----- --- ----- (Plot plan, showing size of lot, location of system in relation t e Is, buildings, et ., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY----- ---- -------- -- - - ---------------------------------------------------------- DATE.--- ----------------------------- REVIEWEDBY--------------------------------------------- ---------------------------------------- -------------------------------- ----- DATE----------------------------------------- ------------------ BUILDING PERMIT ISSUED--------------------------------------------------------------—.-------- -------- ----- DATE----------------------------T-------------------------------- Alterations and/or recommendations:--------------------------------------------------------------------------------------------------------------------------------------------------------------- J" ------------------------------------ -------------------------------------------- ----------------------------------------------------------------------------------------------------------•-------------------------------- 4 a -------------------------------- ------------------------------------------------ ------------------------------------------------- -------- ---------1 7........... ------------------------------- --------------------------------- ----------------------------------------- - ------------------------------- -------------- ---------------------- ...... .............------------------------- ------------------------------ ---- ----- - --- I--- ----- ----------------------------- Date FINAL INSPECTION BY:.-- - -- - _ t / ----------------- _ - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Ha:ellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocklon,California Lodi, California Manteca,California Tracy,California F.RCU.