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FOR OFFICE USE: `� M APPLICATION FOR SANITATION PERMIT Permit No.l. 3..:: „--------- - -- ------------------------- ------- (Complete in Duplicate) Date Issued ��_:�.1�: •� ------------------------------------------- This Permit Expires 1 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. I JOB ADDRESS AND LOCATION' %__ _- _C._ -----t-r---_--------------- , Owner's Name !A ¢'gT � �' rr'f - ne Address ., - I'71 ------------------------------------------- - a Contractor's Name------------------ r E - Phone - - } ----- -- --- ------------- Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Trailer Court tel ❑I Other ❑ Number of living units: Q Number of bedrooms __. ___ Number of baths -------- Lot size _-__._________._ - Water Supply: Public system E] Community system P-rivate ❑ Depth to Water Table /. -_ ft. Character of soil to a depth of 3 feet: Sand ❑ Grave! [-] Sandy Loam Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ �V I Previous Application Made: (If yes,date__.-__.-_..-__..___f No ❑ New Construction: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: �i S (No septic tank or cesspool permitted if public sewer is available within,200 feet.) \C1 j �.} Septic Tank: Distance from nearest well-----------------Distance from foundation--------------------Material----------------------- ------------ _------------ _. ❑ No. of compartments-------------------------Size-------------:----------- -- ---Liquid depth-------------------------Capacity---------------------- Disposa field: Distance from nearest weT..J'd_I-/--_.Distance from foundation------/-b-........Distance to nearest lot line._ ---- ______ Number of linesI_____-___Z-----------------------Length of each line------/_C_iP__�----------Width of trench------_ .-------------------- Type ---_-------------._ i T e of filter material-----4A— _____De Depth of filter material ...........Total len th___-_!_a4�__'_____________________ Yp 1 ---- p �/ g �. Seepage•Pit: Distance to nearest well---------------------- from foundation--------------------Distance to nearest lot line_____---_______-_ ❑ Number of pits-1-------------------Lining material-----------------------Size; Diameter.----------------------Depth--------------------------------- Cesspool: Distance from ni earest well-----------------Distance from foundation -----------.lining material......._:-____-_________________. ❑ Size: Diameter-------------------- - -Depth--------------------------------------------------------Liquid Capacity- --------- ---- ---- ----gals. Priv Distance:.•from"nearest well ---------------':-_a----------------------------- Y' �: ,. -. Distance from nearest building----------------------------------------- ❑ Distance to nearest lot line-- --- ----------------------------------------------------------------- ------------------------------------ ------------------------ ------------------ +: Remodeling and/or repairing (describe):------- - --------------------------------- •; -- ----------------------------------i==`----------------- t i l ------------------------------------ ------------------------ -------------------------------•-------------------------------------------------------------------------------------- •-------------------------------- I hereby certify that I have prepared.this application and that the work will be done in accordance with San Joaquin County ' ordinances, State and rules and regulations of the San Joaquin Local Health District. - .: 3 (Signed)----------- - --- --------- --- = f ==- -j9aereet•-end/ar Contractor) '-�,-,1�,' --------------------------------------(Title)----------------------------------------------------------- By:(Plot plan r showing size of lot, location of ystem i relation to wells, buildings, etc., can be placed on reverse side). t FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY./ -------- ---------- -- ---------------------------------------- DATE--/- -. ?� f � --------------- REVIEWED -------------REVIEWED BY -------- ------------------------------------------------------------- = _PATE - ------------------------ ------------------------ BUILDINGPERMIT ISSUED--------------------------------:--------------------------------- ----------------- Z---------- DATE k--------------------------------------------- ------------- Alterations and/or recommendations------------------- � - -------------------------•-------•-----------------------•---------------------------- I ---------- ------------ -- -- --------------------------- -------------------- ----------- -------- -- s ----------- --- - - -- --------------------------------------------------------- ------------------------------------- -------------------•----------•-------•------------ ------------------ ------------ ---------------- --•------------------------------------------------------------- - -- FINAL INSPECTION BY:-_/lsTi-r""', = r!,a...? _ _-._. Date-- -�--'Z'- - --- ------ ------- ------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT ` ! 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street ` { Lodi,California Manteca,California Trac nia 5tocktan,California �. Y.Ca !! F yr