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FOR OFFICE USE: -- Permit No. � �� -- - --- APPLICATION FOR SANITATION PERMIT - ----------------------- ----------------- ---------------- _______ (Complete in Duplicate) Date Issued This Permit Expires 1 Year From Date Issued nd install the work herein described. Application is hereby made to the San Joaquin Local Heal+h District for a permit to construct a This application is made in compliance with County Ordinance No. 544. le ..., JOB ADDRESS AND LOCATION _�'y`----'--- A ----------------------------- Owner s Name-, �J Jam/ _____ -_ -s--- -•�'P-- """---------------------•-------•------------_.-..______.___..__.._._______.___.___.__________._ Address Phone------------------------------------ Contractor's Name--------------------------------- -•----••--'--- ----- -- Installation will serve: Res-silence Apar#ment House ❑ Commercial ❑ Trailer Court ❑ Mofiel ❑ Other ❑ ' Number of living units: __-r___ Number of bedrooms _- Number of baths _�----- Lot size ��- '--------------------------------- Number ------ -- -------'----"•- t. Water Supply: Public system ❑ Community system ❑ Private �epth #o WaferTable Cla f❑ Adobe❑ Hardpan A. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam [Clay L ❑ Y 1 _ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No Previous Application Made: (if yes,date----------- ----- -) No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic Tank: Dis#ance from nearest well-------_---------Distance from foundation--------------------Material-.-- -Ca acit No. of compartments----- --------------------Size------------------------- -----Liquid depth-------------- P y-------------------- Disposal Field: Distance from nearest well-----------------Distance from foundation--------------------Distance to nearest lot line----------------- ❑ Number of lines---------------------- ------------Length of each line-----------------------------.Width of trench--------------.--------------------- De Depth of filter material----- -----------Total length------------------------------------------ Type ---------------- ----- ` p �} Type of filter materia_--�----------------- - 1 __ Distance to nearest well.-.___1'_4)01 .,__.Distance from foundation___�p_-"______--.Distance to nearest lot line__--_-__- -- Number of pits------/--------------Lining material----- $�.�, Size: Diams4er-_X_'k-�-'t Dept,,----�'r Cesaool: Distance from nearest well______-_" ___-__Distance from foundation--__-___--_---__--.Lining material"----------------------------------- # Li uid Capacity gals. ❑ Size: Diameter--------------------------------- ----Death- ----------- ---------- -------- -------- ----- q P y---------------: from nearest building--------------------------------------\ Privy: - Distance from nearest we __----.-----`--=-==--- ----------------------------- ❑ ----------------- ------------ ---------------- Distance to nearest lot line----------------------- � - r h i Remodeling and/or repairing (describe :1111______ _____ _ _ __ fry .r- ------------------------------------------- ------ --- ------------------ --------------------------------•-------------------------------------------------------------------------------------------------------- -- Ihereby certify that I have prepared this application"and that the work will be clone in accordance - ordance wit an Joaquin County ordinances, State laws, and rules and regulations of the San .Joaquin Local Health District. - ------------------ --- ---- -------- ----- ---------- --------- -------- --------- -------- - and/or Contractor) (Signed)- ----- --- ---- --- --- ---- -(Title)---------- ------- ------ - -------- - - -- ---------- �Y= (Plot plan, showing size of lot, Location of sy tem in relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY DATE �'f f - --------- -------- APPLICATION ACCEPTED BY----/��-- -- -- ---------- -- ----- ----- ----- - - ---------- � REVIEWED BY-------------------------------------- --- --- - ----------------------------------------------- -- ------------------------------ --------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED---------------------------------------------- ---------- - --------------------------------------------------------------------- --- ----------------- -- Alterations and/or recommendations*------:-- --- --- -----_---._---- --------- --------- ------------------------------------------ I -- - - ------------ ---------------------------- - ------------------ FINAL INSPECTION ----- Date. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.INa:olton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California