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FOR OFFICE USE: G ------------------ ----- R t APPLICATION `FOR SANITATION PERMIT Permit -------------- - {Complete in Duplicate} --------------------------------------- -------------- --- This Permit Expires 1 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"n compliance with County Ord' nce No. 549, E-• ��JOB ADDRESS AND CATION _ ---- --- --- -- OwnersName - - r -------------------------------------------------- -------- Address ----- ---- ------ - - Contractor`s Name--•---------------•-- --- .� � i /Z- - _ ,� _ � .. . __€_ Phone------------------s� 1 F'.' , Installation will serve: Residence f Apartment House+❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: __f_ Number of bedrooms _ _ Number of baths --./ Lot size ._.`p __, __./4 _�------------------- Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table 9-�4_ ft. y. 1.. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,dote-------------- --) No New Construction: Yes ❑ No [r�PIA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) ept' Tank: Distance from nearest well-----------------Distance from foundation--- -------------Material------------------ _.___.______.____.__._---.. No ofcompartments----------�- - -----------Size------• ------------------------Liquid depth---- ---------------------Capacity----------------� Disposal Id: Distance4rom nearest well .A- __..''-Distance from foundation/L4-----------Distance to nearest lot line,,,,S__- Number of lines,--------/__. --Length of each line--------- _S.. ------Width of trench.___ ._Cx�_.---_-__-_Of-----._ Type of filter material- c ___Depth of filter material_----_�-___-.-_._Total length___'________________ ---------- Seepage Pit: Distance:to nearest well-_---_---------------Distance from foundation-------------------Distance to nearest lot line----------------- r ❑ Number of pits----------------------Lining material-----------------------Size: Diameter-----------------------Depth--------------------------------- 3 Cesspool: Distance from nearest well_---------------Distance from foundation....---- -_--.-._.Lining materiel-------------------------------------- ❑ Size: Diameter----------------- --- ------------`---.Depth---------------------------------------------------Liquid Capacity----------------------------gals. Privy: Distancefrom nearest well---------------=-------------------------------Distance from nearest building__-__..-----------__:________________--- ❑ Distance to nearest lot line-- ----------------------- ------ - ----------------------------------- ------------------------------------------ -------------------------- - i - Remodelingand/or repairing (describe):--------------------------------- ---------------L-=--•-•----------------------------------------------------------------------------------------------- -----•----------------------- -------------------------------------------------------•---------------•-----------------------------•---------------------------•------------------------------ f *' I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinances, S e laws,,andtrules and re lations of the S� Joaquin Local Health District. ��✓/J ( wrier and/or Contractor) I (Signed)------- --------------- ---- ---------- ---- ----- ------------ --------------------------- -- --- � --- :-- {Title} (Piot plan, showing size of lot, location of system in relation to wel buildings, etc., can be pi ed on reverse side. FOR DEPARTMENT USE ONLY ' r APPLICATION ACCEPTED BY------ -- -.---- -- _------- -------------------- DATE y r� f. .�.. :s -------------------- REVIEWED BYti. ; .� ---------- ----------------------- ---------- DATE BUILDINGPERMIT ISSUED-------------------------------------------- --------------------------------------- ----------------- DATE.--------------------------- -------------------- ---------- Alterationsand/or recommendations:----------------- --------------------------- - ------------------------------------------------------•----------------•--------- ----------------------------- -------------------------------------------------------------------------------------------------------------------- ------------- ------------------------------------------ ------------ --- --- - ------------- ---------------------------------------------------- --------------------------•------------------------------------------ ------------•--- -------------- ------------------------------- ----------------------__---------------------------------------------------------------------------- ------------------------------------ -•• ------------- ---------- -------- ----------- ---------------------- - - ---------------------- -------------------- ----------------- --------------------------------------------------------- -------------------------------- FINAL INSPECTION BY:.�`:-.. = Date.... / -. ! - - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Slocktonr California Lodi,California Mantecar California Tracy,California F.P.CO.