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FOR OFFICE USE.. Permit No. ------------------------------ ""- " - -- APPLICATION FOR SANITATION PERMIT ----- ------ ----------------------------- ------- (Complete in Duplicate) --e Q e�- p } pate issued _��----- "" ------------------ -- - This Permit Ex fres 1 Year From Date Issued an Joaquin Local Health District for a permit to construct and install the work Application is hereby made.to the Sherein described. This application is made in compliance with County Ordinance No. 549.k �LA1 -- --------- JOB ADDRESS AND OCATIO `(1. ---'- '--------------- ------- '----'- ----- Pone----•-------•-------•----------•-- Owner's Na Address_ - ------ ---------------- one ------ � - ----- -- -- - ------ House - - - Contrac#or's Name------ __ _" -- Motel Other ❑ Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ / ----------------------------- Number of living units: ---/-- Number of be _ Number baths W Lot size _____ _____________ _�•�"" I y y Private �epth to Water Table ____-- f#• V Water Supply: Public system ❑ community system ❑ Clay Loam Clay ❑ Adobe ❑ Hardpan ❑ Character of soil to a depth of 3 feet: Sand ❑ Gravel ❑ Sandy Loam ❑ Y A: Yes E] No Ell Previous Application Made: {4f yes,date--------.........:...7 No ❑ New Construction: Yes {] Na ❑ PHA/VA. TYPE OF INSTALLATION AND SPECIFICATIONS: J ` (No septic tank or cesspool permitted if public sewer 1s available within 200 feet.) Septic Tank: Distance from nearest well_"______________Distance from foundation uic3__de }h Material -_-- - Opacity__.___ .-------------- --- ._--.__ _-.__ V� ❑ No. of compartments._._. ---'- -----'- --Size-------------------------------- q P • � G Dispo Field: Distance from nearest well __,��- -.--Distance from founds 'on_�/'.d---�--- Distance to nearest lot line"_______________ 'h Number of lines------- -- --------Length of each line �� 1 �3 Width of trench.._ j ' Type of filter material__"_.__ -= Depth of filter material-.--.-AV_.---____Total length :._7"-----=--------------�--'- ' i t 1z d.:.___Distance from foundation____./O________.D�stance to nearest lot`in�_________________ D+stance to nearest.well-----.�---- tn------- ----------------- Depth /. -- Number of pits-- '-- 1--'----'--Lining material...-...... ''-- Size: ®rametera- p . . .. _.: -.x . __.___- Distance from foundation----- - -------- Cesspool: Distance from nearest weV4___ Liquid C pac ty_________..____ __._.-__gals. -- th-----------= -----' -----------' ❑ Size: Diameter------'----- -------°--'--- --- --De p ----- --Distance f Distance ------------ rom nearest building-----'--------------------------------- from+nearest well -------------- Privy: t - -- ----------- Distance ----'--'Distance to nearest lot line.----...F----------------------------- --- i `°--^ - --------;�_ --- Remodeling and/or repairing (describe):_____---__. ._-- - . -------------------- ------------------- --- I ---------------------------------------------------- --- --------------------------------------------- ----------------------------------------------------------------------------r6 - ---- -- I hereby certify that 1 haves pre red,fhi ons olf the San Joaquin i the L cal Health be done n accordance with San Joaquin County ordinances, State F l ------------------------- (Signed) rid/or Contractor) a I ---- ---------- ----- ----------' ----------------- By:----- -------- ------ ------------ - --- buildings, etc., can be placed On reverse side). (Plot plan, showing size of lot. Iocation of syste i relation o wells, i FOR DEPARTMENT USE ONLY DATE----,�------- -------- ---------------------------------- APPLICATION ACCEPTED BY"". ._ -- --- - ------ REVIEWED BY----- --------------- ----- ------ BUILDING PERMIT ISSUED------- ---------------------------------------- --------------------------------- ' -------------- Alterations and/or recommen ations:._._______.___.__".___________.__"._._.._------------------------------------------------- ------------- ' --- -------'--------- ---------------- ----------------------------------- Date. .- FINAL INSPECTION BY:_. -- - -'- -- - '-- ' -- ------' --�------ --- - _ SAN JOAQUIN LOCAL HEALTH DISTRICT 1801 E.Fla:elton Ave. 300 West Oak Street 124 sycamore Street 205 West 9th Street Lodi,California Manteca,California Tracy,California Stockton,California � . F.P.CO.