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OR OFFICE USE: - - -�1 --------- i _...____ _._. APPLICATION FOR SANITATION PERMIT Permit No. l� _1...� ------------ -- ----------------------------------------- (Complete in Duplicate) ------------------ I This Permit Expires Year From Date Issued Date Issued _93_- � 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_J1 .1-6 ------------- �i� -��- ---- - - ------------------------------------------ Owner's Name______________ / - G Address ---------------------------------- ContractorsName-----------------•-----••-------' ----------•---------------------------------------------- --------------------•----------------------- Phone----------------------------------- 1 Installation will serve: Residence ---Apartment House .❑ Commercial ❑ Trailer Court ❑ Motel ] Other ❑ - Number of living units: !Number of bedrooms 3__ Number of baths __?"Lot size ._ _=+�" �-__i------------ Water Supply: Public system ❑ Community system ❑ Private Depth to Water Table ... ft. Character of sail to a depth of 3 feet: Sand [] Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay 0-_A6obe [❑ Hardpan ❑ Previous Application Made: (If yes,!date______..___.---_-._-.) No ❑ New Construction: Yes i Vj/No F] FHA/VA: Yes ❑ No El TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) !J Septic tri: Distance from nearest well--f— ---Distancetfromsfoyndatiorq.... ------Mat L.-_ / -' ..___------ -- _ No. of compartments____----�_ Size_____..__ __ d �C�f-L d de th__._.___ _.-------------- L ._ f ��-f- ------. - lqu+ R � ---------- Disposal ekd: Distance from nearest well-_- .f>- -._Distance from(found,}tior�__ f? Distance to nearest lot�e__`� __ Number of lines!----:___._ -------- ____Length of each line__ __U)_ .G __._ ..Width of trench._____ ` Type of filter material-_____ r9- epth of filter material____- .Total length------ ~ ,s Seepage Pit: Distance to nearest well_____________________Distance from;foundation_________________.Distance to nearest lot line________----------------- 1 ❑ Number of pits-1---=--------------Lining material-------------'--------.5lze: Diameter---------.------------- DepA--------- Cesspool: Distance from nearest well-----------------Distance from6undation------.------s---_ Lining material--------.-------.-------------------- � ElSize: Diameter --- ---._. _.-De th--------------1-------------------------------------Li Liquid Capacity p 9 P Y gals. Privy: Distance from nearest well______________--_a_____-_____.____-_._.___!_--.-.-Distance from nearest buildin C,, ❑ --... 4 ` , Distanceto nearest lot line--------------------------------- --. •---------------------------------.-- ---- � ------------------------------ -- ` Remodeling and/or repairing (descr be):_-- ----- --------- ----------------- ---------- ---------------� ` - --------------- ------ ---aL-------=I --------------------------------------I-------------------- ----- - ------------------------------------- --- ------------------------------------------------------------------------------------------------------------------------------------r-------------------------------- - ---- ------ I hereby certify that I have pre 4pared'this ap•plicetion 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. (Signed'------ ----------- ------------ -------0--- ----- ------------------------- ------------------------------------------(Owner and/or Contractor) .. it (Signed$<------ �--- -- --------------------------------------------------- (Title)-------------------------------------------- --- --------- (Plot plan, showing size of I t, location of system in relation to wells, buildings, etc., can be placed on reverse side). y FOR DEPARTMENT USE ONLY APPLI6ATI0N ACCEPTED BY------- I ----- - �''Y�------------------------------------- DATE...... ��.�-��-t�, r %, REVIEWED BY ------------------ DATE--------_I------------ BUILDING PERMIT ISSUED--------------- ------------------ ----------------------------------------------------------------- DATE------------------------------- --- Alterations and/or recommendations--------- f SI -= --- ----- ---�-�-- ------------- ----------------- ---------- ---------- - ---------------- f -.._: _ _.._ FINAL INSPECTION BY,...... Date----- �/ �--------- -- - - - SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocklon,California Lodi,California Manteca,California Tracy,California F.P.CO.