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FOR OFFICE USE_: --- --------- --I Permit No. ---------- --------- APPLICATION FOR SANITATION PERMIT --------- -------- --------- ------------------ ----- ---------------------- + (Complete in Duplicate) f7� Date Issued 4 --- ------------- - --------- --- _- This Permit Ex fires 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. r /fy - - ---------- JOB ADDRESS AND LOCATION, f Owner's Name u -:------------------ -------- Phone- 1_...1 -------------------------------------- Address ----••----•-----------��/-' - � --.-------�-J�.l--.�-- �------�'`� '- - -- --- ---------------------------------------------------- - -------- Phone-------------- ------------------- Contractor's Name____ Installation will serve: Residence ❑ Apartment House ❑ Commercial ❑ Traile rt ] Motel ❑ Other ❑ Number of living units: --1---- Number of bedrooms __ Number of baths - ----- Lot size --- ---- ----------------------------------- Water Supply: Public system ❑' Community system ❑ Private Rj Depth to Water Table 1-.PVft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sanity Loam ❑ Clay Loam ] Clay ❑ Adobe El Hardpan 1 k6New Construction: Yes E] No ❑ FHA/VA: Yes F1 No El Application Made: (If yes date___-__-_-, ---__-) No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: [-�. ;: (No-septic'tank'or-cesspool-permitted'-if public sew'er``is-av#ilabli within"200-feef.)'� Septic Tank: Distance from nearest well_ Q�----Diskan e�rf om foundation_______ _ _______Maternal____ ... _ _._ _.--__ e� Size t'..sr--._--Liquid depth--- - ----Capacity---� -------- No. ------- No. of compartments---- --------------- 3--•- h Disposal Field: Distance from nearest well__e �---.-Distance from foundation:__-Q__�____.-.Distance to nearest lot li -47------.--- {, Number of lines-- ---1___-------bb---------------Length of each line----- �' --------------Width of trench._ ------------ Type of fIIfer!mate riaA.1l.!------ ----Depth of filter mate ria _ �`'--------Total lengthl-&-lo------------------------ Q ------ Seepage Pit: Distance to nearest well--./� __07 -_.._ _Distance from �f undation___ .a.t___.__.Dist�nce to nearest lot lin!________________ --- - - Deptn_ r- -- - - m _ 3- t-_- ---------------- 3 I-1 Number of pits-'- - ----- Lining materia- - Cesspool: IV Distance from nearest well--------------_Distance from 1founda#ion__________________.Lining material----.-------------------------------- Size: biameter#_._._`------------------ ------- Depth---------------° ) ----------------Liquid Capacity gals. ------ Privy: Distance~"'�"" I -__Distance from nearest building-__ Distance from nearest well---_--------- -------------- ----------------------- ----------� ' r ❑ Distance to nearest lot line...-------------------------- '�-`�---- ------------------------ ----------- ------- Remodeling and/or repairing (describe:_-__________________ -------------------- - ------------- --------------------•-------------------- V ----- - -----------------k-------------- --•-----------------------------------------•----•---- - - = - -�'. '�---- ---------------------- --------- - --------- L _ ----- ---- --- _ --------------------- i I hereby certify that I have pared this application and that the work will Cedone ------ T____ n o dar>ce with a�n Joaquin County ordinances, Stat aws, and rules and egulations of the San Joaqui ocal Health District. 1 ------ (Signed) -- ---- ----- _(Ow ---- . -- ..... �__(Owner r .. V. - Rw ._ +. �., ,.:,r.,� (Title) -- -- ----------- ------- and/or Contractor Y. -��„d �, — (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). ( FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY Ysy,r+�-^ ----------------- DATE--�'" _ �� --------------------- REVIEWEDBY---- ------------------------------------ --- --------------------- ---------- DATE----------------------------- ------------------...------- BUILDINGPERMIT ISSUED---------------------------------- -------------------------- ---------------- Alterations and/or 1•ecommendations:__.------------------------------------- ----•----•------------------------------------ ---------- -------------------- - --- -------------------------------- / FINAL INSPECTION BY: -- -- -- --. r2- _� ---------- Date-- --------- t SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxelfon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Lodi,California 1* . = Manteca,California Tracy,California Stockton,California " F.P.CC.