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lOxf0 OFFICE USE: �' � - � 1�3 = �?. Permit No. _.•--- APPLICATION FOR SANITATION PERMIT f (Comple#e in Duplicate) Date issued - ------ ------------------------------------- This Permit Expires 1 Year From Date Issued ---------- - Application is hereby made to the San Joaquin Local Wealth District for a permit to construct and install the work herein describe . This application is made in compliance with County rdinance o. 544. t -------- - ------------ -- - --------- ----- ---- -----•---------------------------•------ ----- + � JOB ADDRESS AND LOCATIONPhone Owner's Name-------- - ------------•----• --------------- Address----------------------- one -------- Contractor's Name----__. Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court [I Motel [j Other ❑ Number of living units: __�_. N ber of bedrooms ---_ Number of baths __r/__ Lot size _/ ---- .r-------------------- % Private Depth to Water Table Water Supply: Public system Community system ❑ ❑ p a Clay E] Adobeardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel F1Sandy Loam ❑ ClY Loam ❑ No NA/VA: Yes ❑ No ❑ Previous Application Made: (If yes,date--------- ------- --I No ❑ New Construction: Yes E1l r TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) 5 tic Distance from nearest well________________Distance from foundation-------------------Materia------------------------------------------------- Size ---.____---__-_.------------------------------ �� No. of compartments------- ------�--------- Size---------------- ------- ------Liquid doh----- -- --- ------- Capacity--------- --- --- -- OP- -_.Distance to nearest lot line_____---- D' osal e d Distance from nearest well-0 t ` Distance from foundation___ ---� Width of trench"114Z11 --------------- Number of lines_._.f_---- -------- ---- - --Length of each line__-r -----�� ,f L Type of filter materia ---- ---Depth of filter material__-- ----------Total length--------- -- -------------------- - ___Distance from foundation_______ ---___.Distancerto nearest to lin _r___-_- Seep ge Pit: Distance to nearest well-- _ ----_--Depth --- -- -- Number of pits__.I_------- _______Lining material-Ra- ----- jj Size: D ameter____ Cesspool- Distance from nearest well-----------------Distance from foundation------------___._-.Lining material___._._---.-------------------- als. ---Depth----- -------------- ------ ------ ------- Liqu;d Capacity ------- -------- -------g ElSize: Diameter---------------------------------- - -----Distance from nearest bu;lcling----------------------------------------- V) Privy: Distance from nearest well------------------------ _--_--- --- 15 - --------- Distance to nearest lot line--------- ---------------------------- - Remodeling and/or repairing (describef-------- - - --- - - - -- --- -- --- -- ----•----------- ------------------•--------- -----• -------- -------------- ------------- -------- ----- r i - t --------------------------------------------------- -- . -----------------------•---•----- -------------------- --------- ---- -------------------------------------------------------- O� ----- ---------- -------- --- I hereby certify that I have prepared this application and that the work willbe done in accordance with San Joaquin County ordinances. St to la and ales and regulations of the San Joaquin Local Health District. �7 f Contractor) o -------------- -------------------- (signed� d-- --- ------- -------Lp ' �•�--� �--- - (Title)----- -------- ---- - -- ------------- -- - --- -------- ---- ----- -- (Plot plan, showing size of lot, location of system in relation o wells, buildings etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY ------------------ DATE ---------------- -------------------------------- - ------- -------- DATE------`�-�-- ----�-- - --- ---- - APPLICATION ACCEPTED BY DATE------------------------- -- ------------------------------ REVIEWED BY----- ---------------- - ----------------- - --------------- -------------------------------- BUILDING PERMIT ISSUED ------------------------------------------- Alterations and/or recommendati ns---- ------------_-- --------- f� -------- r ' - - - ------- ------ - -- --------------------------------- ------- -------- ------------- Date-- ------ 1'� FINAL INSPECTION BY------ --------'--� -- ------- ------------------------ SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haselfan Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Lodi,California Manteca,California Tracy,California Stockton,California F.P.CO.