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U1-[-1(_t U/ -/lt ........... ............ APPLICATION FOR SANITATION PERMIT Permit No. ..........lolev.,,;; 1/ ----- ----- -- ------------- -S-7--- --- (Complete in Duplicate) Date Issued ." 13__4_V ---- ------------- - ----- ........... This Permit Expires I 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 AND LO ,r_ATION------- &-----------------------------------------------------------------I------------------------------- Owner's Name------ _ > ------------------------------ -------------------------------------- Phone------------------------------------ --- ------------------------------------------------------ Address ----F,(7-7----- ------------------------------- ------------ --------------------------------------------------- Contractor's Name ------------------ --------- Phone----------------------------------- ----------- - -- -------- ---- Installation will serve: Residence B"'Aparfmenf House 0 Commercial E] Trailer Court E] Motel E] Other E] Number of living units: Number of bedrooms --g.- Number of baths _/--- Lot size J_2?........x----- ------------------- Wafer Supply: Public system Community system El Private E] Depth to Water Table ft. Character of soil to a depth of 3 feet: Sand El Gravel E] Sandy Loam [-] Clay Loam E] Clay E] Adobe B---Tdardpan ❑ Previous Application Made: (If yes,date-..--.--------------) No Ir New Construction: Yes El No [ FHA/VA: Yes D No ©r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Sept;cjank-, Distance from nearest well--_-_- _Distance from foundaf ion-------:-------------Material--------------- -------------------------------- No. of 'compartments--------------------------Size--------------------------------Liquid depth---------------- ---------Capacity----------------------- Disposal Field: Distance from nearest well.--_--—-------Distance from founclaf on---//- ----------Distance to nearest lot line-Al------------ Number of lines________ Length of each line__- ______________._.Width of french._,�?......... ------------------ '7 J Type of filter maferial__/_��_4. 1-ot-Depth of fliter material--- -Total length---9?Z9_/-------------------- ------- Disfancq to nearest well- - -—-------------Distance from foundation----/114---------Distance to nearest lot line-__J----------- Number of pits-------4------------Lining material---X4Pj6k..--.Size: D ia mete r__ --------Depth_ Distance from nearest weil--------------_Distance from founclaf ion ----------..Lining material-_-_---____-_.---_-.__.____-_____-__ ge '�G-� C F00e El Size. Diameter------ --------- ------------- -------Depth-..----------------------------------------------_Licluid Capacity--.-------------------------gals. u"I Privy: Distance from nearest well---_ - -- ---- --- ----___-----__._-`----_.._.-Distance from nearest building_______________________________________. ❑ uilding------------------------------------------ El Distance to nearest lot line--------------------------- ------------------------------------- ---------------------------------------------------------------------- Remodeling and/or repairing (describe}-----------------E0 0...... -------------•--------------••--------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------41------------------------------------------------------------------------------------ ------------------------------------------------------------------------I---------------7------------------------------------------------------------------------------------------------------------------------------------ ------------------------------------- --------------------------------------------------------------------------------------------------------------------------------------------------------- -- ----------- 1-----r------ 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. 41 (Signed)--------------------- ----------- -•----( or Contractor) By:---------------------------------___--------------------------------------------- ----------- - - ---- ----- (Plot plan, showing size of lot, location of system in relation ells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY--------- 4.cr ---------------------------- ---------------------------------------- DATE---------�a _AeX_�----- ----------------- REVIEWEDBY----------------------------------- - ---------------------------------------------------------------------------------- ----- DATE----------------------------------- BUILDINGPERMIT ISSUED----------------------------------------------------------------------------------------------------- DATE---------------------------------------------- --------------- Alteratiogs and ,/or y recommendations:_______. ._____________-------------- --- ------------- ')- ----------------------------------------------------- ------------------------------ . _��;%4z--------- ---- ----- C- -- ----------I-----7 - ----------------------------------------------------- ----------------------------------- -------- --------------------------------------------------- ------------------ --------------------------------------------------------------------- ------------------------------------------------------------------------- ----------------- ------- ------------ ----------------------- ---------------------- -------------------- ------------ ----------1----------------------------------------- ------ -------------- FINAL INSPECTION BY:_---- Date............161A a ------------------------------------------------------ ... .. - -- ---------------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Harellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stotliton,California Lodi,California Manteca,California Tracy,California F.P,00.