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FOR OFFICE USE: - -- --------------- Permit No. :. _ p ------------------- -----._._ - ---- _. - APPLICATION FOR SANITATION PERMIT r -- ---------------- -------- -------" (Complete in Duplicate) Date Issued --------------- ---- ----- This Permit Expires 1 Year From Date Issue 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 LOCATION. --- -- `---"- " ------------------ Phone------------------------------------ --------Owner's NameAddress__-____..__ t ------•----------------- -----------------------------------•--------- Contractor's Name------ - --- - •- -- ---- '------------------------"-----.-. Phone..... _ .� �: Installation will serve: Residence Apartment House ❑ k C-mmercial ❑ Trailer Court ❑ Mo#el ❑ Other i Lot size Number of living units: ___}'Number of bedrooms Num;�Depf�XtWaf -baths•_.._ __ r Water Supply: Public system ❑ Community system ❑ Private er Table --_._--- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (if yes,date..___.__..____--f-1 No F1New Construction: Yes E] No El FFiA/VA: Yes ❑ No El OF INSTALLATION.AND SPECIFICATIONS; ` (No septic lank or cesspool permitted if public sewer is available within.200 feet.) ` Septic �--..--_Distance from found pion_-.----/_!-----__ Material.-._"_ - -------- ank: Distance from!nearest well- a j No. of compartments Size-------"xx.e-_.. -----Liquid depth-------�- --------Capacity--- f} . v Dispos Field: Distance from nearest well_,X1�------- Distance from foundation__t _�._.'.�Distance to neares#�lo�line_________ ______ ` Number of lines---,'__�> --- --------Length of each line------:5A-----------------Width of trench.._ �----__------------------ Type of filter material _...� ial-----i?.°.-.-----.TI otal length----/A/a----------------------------- -.R -------Depth of filter mater 1, Seepage Pit: Distance to nearest well......................Distance fro m foundation------.------------Distance to nearest lot line._.__..._......__ ❑ Number of pits------------- --------Lining material -.Size:.Diameter--------- ------4 Depth_.. __ A V �. dation___________________lining material._.______._._.-..__..__. _ .__ _.__ Cesspool: Distance from nearest well-----------------Distance from rfouri " Liquid Ca acit galsl ElSize: Diameter------ -------------------------- ----Depth------------- ---------------------- ---------- q P Y------------------ . Privy: Distance from nearest well---_--------------------------------------------Distance from nearest building----------------_---------------------- Distance - ❑ - ------------------- to nearest of ine....__._"---_-_"--- ------------ - ---------------=------------------------------------------------ Remodeling and/or repairing (describe)_______________________ ------------------------------------- ------•------------------------------- -1----------------------- ------------------ r l ------------------------------------- ------------------------------------------------------------------- ------- ------------------------------------------------------------------------------------------------------------------------------------------- 1 hereby certify that I have prepared this application 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. + /10 --- - n _x ----- ------ - --(Signed) ---- --------------------------------------- ------------r ----------------- Title - SY:------------- I .. (Plot plan, showing size of lot, location of system in r ation to wells, buildings, etc., can be-placed on..reverse side). ,r FOR DEPARTMENT USE ONLY,------; r y -- - APPLICATION ACCEPTED BY -- ----------- DATE--- ` r ' • DATE----------------------------------------------------------- REVIEWED BY--------------- �----------- ---------- - --------- -=-------------------- ------------------------------------------ } -------------------------------------------------------- DATE------------------------------------------------------------ BUILDING PERMIT ISSUED_----=--------=---__-_--=-- -. �_•e_"�" � :_------ Alterations and/or recommendations---------------------------------- ----------- -------------------------------------------------------------------------- ---------`-------------•--------------------------------------------------•--------- -------- ! 6 ------------------------------------------ - --------------- ------ - 1 , .................................... .................-------------------------------------------------------- ...................................4_.____..._._.._-..----------------------------------------- __ .....................---------------------------------------. ........ _.. ------------------------------ --------------- } --._ t ------------------------- Da -- ----------------- - FINAL INSPECTION BY:. ._ Date-_._. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Sfocklon,California Lodi,California Manteca,California Tracy,California F.P.co.