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F R OFFICE USE: - 2`- S g --------------------------------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. .1.Z.. . ------- -------- - -------------------"---- (Complete�in Duplicate) - ----------------------------------------- - _____________ This Permit Expires 1 Year From Date Issued Date Issued Application is hereby made to the San Joaquin Local Health District for a permit to construct and insta#1 the work herein described. This application is made in compliancewithCounty Ordinance No. 549. JOB ADDRESS AND LOCATIO / i �,� -------- Phone------------------------------------ ------------ Name ---- --•------ - - ��lc,�-- ---------------------------------------------- ----- ------------------------- ---"------•- ---------------------------- Address---------------- .- Contractor's Name Phone t - ---- •------------- Installation will serve: 'Residence [Apartment House ❑ Commercial ❑ Trailer Court ❑- Motel ❑ Other ❑ Number of living units__._____ Number of bedroorrms' .P Number of baths _`___ Lot size / ---------------------------"-- nit system y a 1i _ ��---X Water Supply: Publiesystem �Commu y y ❑l riv$tetT❑ .Depth to Water Table _��ft. Character of soil to a depfWpf 3 feet: Sand ❑ Gravel ❑ Sandy L am ❑ Clay Loam ❑ Clay ❑ Adobe /hardpan ❑ Previous Application Made: (Ifiyes,date_.- _-------------) No 0;-�—New Construction: Yes E] No � --"FHA/VA: Yes [INo VA fr # TYPE OF INSTALLATION AND SPECIFICATIONS:`-,1% (No septic tank.or cesspool permitted if public sewer is available within 200 feet.) Septic Tani: Distance from nearest well------ ___-----Distance from foundation--------------------Material--- --- ---------_-___.--------------------------- No. of,compartments------------ ------------Size-------------------i-----------Liquid depth--------------------------Capacity----------------------- Dispor'I Fief: Distance from nearest well----------------Distance from foundation----------------....Distance to nearest lot line----------------- Number of lines----------------------------- ----Length of each line--------- -------------------Width of trench----------------------------------- _ ---------------- of filter material-----------------------Total length------------------------------------------ v t s / i `* Seepage Pit: Disptance toe of eneaaestlwell__ ��______Distance fr m fo ndation_s�� Distan� to nearest lot I•ne,�r�_"�_._ ®r Number of pits..:.________ ___Lining material_ Z.-Size: Diameter _ ------Depth / .-___-= - N Cesspool: Distance from"nearest'well_~~.~_'_:----Distance-from foundation...:................Lining material------.__.-----------__.__________--- k ❑ Size: Diameter=- :-------------------------------Depth--------"--------------------- ------ --------------Liquid Capacity----------------------------gals. I' ._Distance,from nearest building Privy: Distance from; nearest well------------------ -------------- - {! -----------------------�------------------------------------------------ 0 ---------------------------------- , ❑ Distance to nearest lot line----------------------------- ------ - ---- ---------------- - -- I y Remodeling and/or repairing (describe):__________________ _ _.___.-,___ � ---------------•--------------------•------------- h f ----- -------------------------------------------------------------- - ---------------------------------------------- "-------------------------------------------------------------------------------------`.------------------------------------------------------------------------------ ------------------------ ----------- ------------------- ----------------------------------••-------------------------------------------------`-------------------------------------•---------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County j ordinances, State laws, and rules ranA regulations of j e San Joaquin Local Health District. -1-------------------------------.(Qwr or Contractor] (Signed)------------------------ ---- - - - - --- --- ----- iiV ---- By:-------------------------- -- - --- ------ g P ] - - - ---------------------- -- (Plot plan, showing size of lot, location of system in r ion to wells, buildings, etc., can be laced on reverse side). , FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_._._.__- ----- —f - DATE----------- REVIEWEDBY---------------------------------------------r------------------------------------------------------------------------------ DATE-------- ------- ------------------------------------------- BUILDINGPERMIT ISSUED------------------------- ---- = D --------------------- ------------------------------- Alterations and/or recommendations:--- ---. _ --- �. ------- ------- - I -----------------------•- •---------------------- -------------------------- ------ ---------------I---------------------------- --------------------------- - ------------------------------------------------------------------------- ----------------------------------------------------------------- - FINAL INSPE - - --� Date....--- --_.e / � -� ------------------- ---- _ � SAN JOAQUIN LOCAL HEALTH DISTRICT t "` 1601 E.Hasellon Ave. 300 West,Oak Street 124 Sycamore Street205 W 90i Street Lodi California { MonteCalifornia Tracy,California Stockton,California w•ti. _, 'f .a[ ! 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