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FOR OFFICE USE: ----- -- --- ------------------------------------------- All' �� -- -- ---- -- - ---- -- - ---- -- ----------------------- APPLICATION FOR SANITATION PERMIT Permit No. .._.__._. ... ------------- --- ------------ --- (Complete in Duplicate) ---- -------- --- p From Date Issued Date Issued _ '0�`Z -_-- -_ -_ -- - -_ - This permit Expires 1 Year 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 LOCATION------- / f-------------- - ------- ------ Owner's ----Owner's Name �yz-r4•trc� �- ---------- ------------------ Phone-- e Address-------------------- -----------! ----� -----------r---------- Contractor's Name-- �ti: Z11, Phone--- Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: ---/.- Number of bedrooms _�_ Number of baths -- Lot size ----- `._- ------------ Water Supply. Public system ❑ Community system ® Private ❑ Depth to Water Table -------- ft. Character of soil to a depth of 3 feet- Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe Dd Hardpan ❑ �. Previous Application Made: (If yes,date--------------------) No ❑ New Construction: Yes ® No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: T(No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest well Q ------Distance from foundation----- e---------Material_-____. ❑ No. of compartments-----_--- -_.._-_.Size-lQ-- --__. --__-.Liquid depth______ _________ _Capacity--- Disposal Field: Distance from nearest well-YA)PQ--.-Distance from foundation-AVO---------Distance to nearest lot line-_/49--------- F1 Number of,lines----- ----------- --- - -Length of each line-------00_!------_.-.-.Width of trench------ --------- Type ____ __ Type of filter material--_-_— epth of filter materlaL.fl-_�_�_.__A4_'r'Total length____�-4_t2----- ___ ____..__ Seepage Pit: Distance to nearest well----------------------Distance from foundation--------------------Distance to nearest lot line----------------- F1 Number of pits----------------------Lining material----------------------.Size: Diameter-------------_.......Depth---.- -------- Cesspool: Distance from nearest well-----------------Distance from foundation-----------.--------Lining material------------------------------_----- ❑ Size: Diameter--------------------------------------Depth------ ---------- ---------------_-----------------Liquid Capacity-----------------------------gals. J, y ._ -Priv-""`r — Distance from nearest well ------------ -__--- . -._Distance from nearest building-• ��=___=� w.--T'— � 1 Y - ---------•-----------g--------— --------------------- I ❑ Distance to nearest lot line..___.-._..___._._. _. _._.._._. - - -------------------------------------------------- - Remodeling and/or repairing (describe):---------------------------------------------------------------------------------------------------------------------------------------------------------- ---------------------------------------------------------------------------------------------------------------------------------------------------------------------- -- ---------------------------------------------------- --- --- y ----------------------- --------- ---- ------------------------ -- -------------------------------- ------- --•- --------- -- - --------------_---------------- --i-----------------------..-- -- I hereby certify that I have prepared this application and that +he work will be done in accordance with`San Joaquin County ordinances, State laws, and rules"and,regulaf ions of the San Joaquin Local Health District. (Signed) ..-.----.Owner and/or Contractor a (Title) C (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side).�E- ��,f'/(' FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED B =------------------------------------------------------------------------ DATE.--- &&4-Y------------------=----------- Q it REVIEWEDBY---------------------- ------------- -------------------------------------------------------------------------- DATE------------------------------------------------------- ---- BUILDING PERMIT ISSUED---- ---------------------------------------------------------------------------------------------- DATE.------------------------------------------------ ---------- Alterations and/or recommendations------------------------ ----- x----------------------------------------------------------------------------------------- ------------- ---- --- ---- ----- -------------------------------------------------------------------------------------- t FINAL INSPECTION f E Date -------------------- ---------- S JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Trac Stockton,California Y,California F.P.CO. f