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FOR OFFICE USE: -------- ---------------------------------------- ----- APPLICATION FOR SANITATION PERMIT Permit No. - ------------------ -- -- ------------ ---------- (Complete in Duplicate) Date Issued __ - This Permit Expires 1 Year From m Date Issued Application is hereby made to the San Jbaquin Local Health District-Jor a permit to construct and install the work herein described.. This application is made in compliance with County Ordinance No. 549. p (? ® --- - JOB ADDR Q LOCATION_ J!J`huh -- ----- Phone one Owner's Name - - -- + - ------ -------- - - ------------ Owner's Name ,, ll •-- ----- --- --- -------------------- ---------------- -- ------------ r 'T• k Phone---------------------------------- Contractor's Name--------•-- -- -- ------ - -- _- •--------- -�----- ---------•---••------� - ------•---- Installation will serve: Residence tApartment Hous ❑ Commercial [j Trailer ourt ❑ Motel ❑ Other ❑ Number of living units: _,/__- Number of bedrooms_-. Number baths - ----- Lot size ---------------------- -------- ------------------- Water Supply: Public system E] Community system ❑ Private Depfb Water Table -------- ft. Character of soil to a depth of 3 fee+: Sand ❑ Gravel ❑ Sandy Loam Clay Lqam ❑ Clay ❑ Adobe ❑ Hardpan No ElPrevious Application Made: (If yes,d!ate--------------------) No 1-71 New Construction: Yes E] No ElFHA/VA: Yes E] TYPE OF INSTALLATION AND SPECIFICATIONS: (No septic tank or cesspool permitted if public sewer is available within 200 feet.) s ' - *r ± �LI --- de th- t rial ----- -- ------------ '--- Septic nk: Distance from nearest well__-_` -__.__Dis$anc from foundatior�___:.to_____---.Ma � Capacity-f�pC� - -- ----- ----- --._ X- G p. ------- f No, of compartments--------___� � - Dispos ield:, Distance from nearest well___��.-.-._Distance from foundation.__._ --.-.Distance to nearest lot line______-- -- ------------ Number of lines------------ --------------- Length of each -f...- -----Width of trench..--- T pe rench..--Type of filter material ______-=Z_'____Depth of filter material (_.�/._____ ____._Total length__---' O-d------------- ----- Seep e Pit: Distance to nearest well.---- 0_B- ----Distance from undation______I_a______.Distan�e to nearest lot line____-_______.__ i Number of pits'-.------f----------Lining mater;al__-__-G._-- ___ -Size: Diameter--- fo-.- ------Depth_---s ------------------ - Cesspool: Distance from nearest well________________Distance from foundation-.-.____ __________Lining material____._.___-____--._.____.__-______.__. ❑ Size: Diameter----- ----------------- -----Depth------------------ ---------------------------------Liquid Capacity--------------------------•-gals i - m Distance fronearest building ----- ------ Privy: Distance from nearest well------- ---------------------- - - Distance:.to-nearest lot Dine t - ---------------- ------- Remodeling and/or repairing (descr'sbe):------ --------- - ---------------------------------------------------.___.____,_____._________________________ --------------- ------------------ -- - --------------------- ------ ----- t t f f -------- __her ---y-------- y I hereb c" in at I� ve prepared this application`-and that the work will be done in accordance with San Joaquin County , ordinances, State la s, and r les and re ' lations San Joaquin Local Health District. y > -_�'�WRurand or Contractor - ` / I _ > - ------------------ (Signed) { M -Title --------------- ---------------- ---- ----- - By:------ ----- --- ------ --- ------------- { ] ' Plot Ian, showing size of lot, location of system in relati to well buildings, etc., can be placed on reverse side]. ' FOR DEPARTMENT USE ONLY ' APPLICATION ACCEPTED BY_ DATE-------------------------------------------------------- REVIEWED BY----------- ---------- -------------------- -------------------------------- - ------------------------------------: DATE-----------------•--------------------------------------- _ BUILDINGPERMIT ISSUED--------------------------- • - ------------•----------------------------------r------ DATE-- -- --------- -------------�----�------------- ------- -- ` Alterations and%or recommendations:------------------ --=-----•-------------------------------------•---------- ----------------------- ------------- I ----- --.--- • --------- ----------------------- -------- ---------------- ----------- v"--1 -- ------------------ --- --- ------- Date--------- � -�--- --------------- ----------------•---- FINAL INSPECTION BY:----- ....... ...... .. .. SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Havolton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Brockton,California Lodi,California Manteca,California Tracy, California F.P.CO.