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` �OR OFFICE USE: -------'� �'- fes- --=�-----�r�--'�'- .----_ ' -- ., - APPLICATION FOR SANITATION PERMIT Permit No. /,01 �_ J --------------- -------• --------- --- ------- {Complete in Duplicate) '' J ______________ This Permit Expires I Year From Date Issued 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 Or 'nance No. 549. JOS ADDRESS A LOCATION ---- ..... -- ----------------------------...... ----------------•---------.-- Owner's Name ------ ------ Phone------------------------------------ Address--------------- > = liter-'�' •- Contractor's Name--- ------- ' , � � ---------------------- Phone....-------••----- ------ Installation will serve: Residence ®,"Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: J---- Number of bedrooms Z... Number of baths __-____ Lot size _------------------- r Water Supply: Public system E] Community system [1Private R"'Depth to Water Table X_4-ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam [] Clay ❑ Adobe Hardpan ❑ Previous Application Made: Ilf yes,date....................1 No ORO"'New Construction: Yes ❑ No 20" FHA/VA: Yes ❑ No K;- TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 204 feet.) Septic Tank: Distance from nearest well------------- Distance from foundation--------------------Material-------------------------.________________--_--_. No. of compartments-------------------------Size----------------------- ---Liquid depth--------------------------Capacity----------------------- Disposal Field:f Distance from nearest well--- from foundation. 0------_-Distance to nearest to line_-- ---____- Len th of each line____ _ Number of lines OF 9 Width of tren h r "V Type of filter material---/ _ _ -Depth of filter material_._. -----Total length____#_ ____________ Seepage Pit: Distance to nearest well---------------------Distance from foundation----------------.__.Distance to nearest lot line__.________._-_._ \ ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth---------.---------------------_. Cesspool: Distance from nearest well-.................Distance from foundation------------.-------Lining material-------------------------------------- El Size: Diameter--------------------------------------Depth----------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distance from nearest well------------------------------------------------- from nearest building----------.--------------.--_----_--,--. ❑ Distance to nearest lot lire-------------------------------------------------------------------------------------- ------------------------------------------------------- Remodeling and/or repairing (describe)=----------------WZ&- )Qc _�? ''-------------------- -------- ------------------- ---------------------------•---------------------------------------------------------------------------------------------------------- -------------------------------------------------------------------------------------- --------------------------------------------------------------------------•---------------:--------------------------- ------•---------------------------------------------------------------- ___4____________________ _____________________________________ _____________________________________________________________ ___________________________________________ ____---_ ..---_____. ._____._._-..________.._.__---------- 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. --- T (Signed) .--`�= '��G�----�----------------------------------------- ---- ----------------------------------- ------ fir Contractor1 ------------- -- -- - By:-----------------------------.------------------------------------------ ------------- Title (Plot plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED ------- ---------------------------•---------- DATE-----... ----------------- REVIEWEDBY--------- --------------------- _-- ------------------------------------------------------------ DATE-------- -------------------------------------------------- Alterations and/-or recommendat-ions:----------------------------- ------------------------------------------ ---- DATE------ ------------------- ti----------•----------- 4?, l.r v- 1- - �� .z r U- �' --[�r'17. BUILDINGM I _C—'�.` er- O—t.•�.—c._-`- -- ----------------------------- - _ -� r -ice, -� t FINAL INSPECTION BY:C/L -- cr `�� Date-_.....-- - ---�� '•� :- AN JOAQUIN LOCAL HEALTH DISTRICT 1641 E.Haxelton Ave. 00 West Oak Street 124 Sycamore Street 205 Wesl 9th Street Slockton,California Lodi,California., v,;� Manteca•California Tracy,California