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FOR OFFICE USE: APPLICATION FOR SANITATION PERMIT Permit No. - -------------------------------------------------------- .. .- -------------- (Complete in Duplicate) ••� Date issued --------------- ------------------------------------ This Permit Expires I Year From Date Issued Application is hereby ma a to the 5 n Joaquin Local Health District for a permit to construct and install the work herein described. Pp p y No. 549. This application a n c Iia with Count Ordinance o JOB ADS�� OCATI r Owner's Name----- -- Phone_ Address------------- - ------je, ;o �'--/i,��,�� '-r --- ; ....-----------------•------------------------------•- Contractor's Name--------- ---- F -------- - `�" --------- Phone---------------------------------- Installation will serve: Residence 2r"'Apartment House ❑ Commercial ❑ Trailer Court ❑ Motel ❑ Other ❑ Number of living units: _/--- Number of bedrooms _ Number of aths _�ot size _____ rt n -----------•----------- Water Supply: Public system El Community system ElPrivate Depth to Water Table -------- ft. Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ®� Previous Application Made: (If yes,date__--------____---__) No ❑ New Construclipn: Yes ❑ No ❑ FHA/VA: Yes ❑ No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) Septic k: Distance from nearest well___-.T Distance from foundation____t¢__.____.Material____--- --.--. No. of compartments_----'?!7�---------Size4&O'-' _'47 Liquid depth-----. i!f-------------- Capacity________--_ F 'V pispos Field: Distance from nearest welL__ ___ Distance from foundation._]__.__.___Distance to nearest lot I�e-----.�"____. Number of lines----------- ----------------Length of each line-------�____.__------------Width of trench.. �.----------------------- Type of filter material--____-S°��_ ___Depth of filter material--__-__,(_ _`.__Total length_______ _________________ Seeps Pit: Distance to nearest well---�_��d_--------Distance from y�foundation_ Distance to nearest lot I'sneR______________ Number of pits-_..----'F?�------Lining matenal__._�'/S__i....Size: l}iameter.____72.°._____Deptn_..!��___________--- - _ Cesspool: Distance from nearest well-----------------Distance from foundation--------------------Lining material-------------------------_----___--- _. .� ❑ Size: Diameter------------------------------------ -Depth--------- ------------------------ -----------------Liquid Capacity-- -------------------------gals. Privy: Distance from nearesf we!!-------------------------------------------------Distance from nearest building------------------------------------------- ❑ Distance to nearest lot line-------------------------------------------------------------------------------------------------------------------------------------------- emodelin nd/or repairing (describe):-------- - ------- ----------------------------------------------------------•-----------------------•------- ----I------------------- -------- ------------------------------------------------------------------._...---------------------- ------------------------------•-•---••------------------------------------ ---------------------------------------- -------------•---- ----------------------------------------------------------------------------------------------------------------------------------------- I hereby certify that I have prepared this application and that the work will be done in accordance with San Joaquin County ordinance6SIaws, and rules ulations of the San Joaquin Local Health District. (Signed --- ------------ --- - ------ - ------- ---- -------- ------- --- ------------------------------------------------- ----------------- r and/or Contractor) QY - ltle___--__ _ _ -(Plot plansize of lot, location f syste relation to wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY_-- f .' 'y"' ' " ' ----------- DATE--_- -`f �_' -� = - ---------------------- - - REVIEWEDBY--------------------------- F--------__------------------------------ -------------------------------------------- DATE------------------------------------------------------------ BUILDINGPERMIT ISSUED-------------------------------------------------------------•-------------------------------------- DATE.-------------------------- -------------------------------- Alterations and/or recommendations---------------- --------------------- ------•--------------•-----------------------------------------------------`------------------- ------------- -1------------------------------------------------------------------------------ -----------•------------------------------------------------------------------------------ - --------------------- ---------------------- ------------------------------------------ FINAL INSPECTION BY:_-�'j' " �y � ."r� Date--- l /� -------•---- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Haxellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 91h Street Stocklon,California Lodi,California Manteca,Carifernia Tracy,California F.P.Cd.