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FOR OFFICE USE: i ----------------- ----------------- ------------- APPLICATION FOR SANITATION PERMIT Permit No. -------- --------------------------------- - ---- --'1..- (Complete in Duplicate) / a ------------------------------------------- -..- ---:--. This Permit ExpCres T Year From Date Issued Date Issued 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 compiance with County Ordinance No. 549. JOB ADDRESS ' LO ATION1 - --------- - = '-------------- -------------------------------------------- Owner's Name_'. ------ 'Phone-------------------------•---------- -- ----Address 7 - I - --- -- -- --------- •------------• ------ Phone--------------........ ------ Contractor's Name � � Installation will serve: Residence E] Apartment House Ej Commercial E] Trailer Court Motel ❑ Other ❑ Number of living units: 1 ` __. Number of bedrooms o at __ ___ Lot size ______'___________ Water Supply: Public system ❑ Community sys m ❑i Pri ate Depfh, to Water Table ________ ft. Character of soil to a depth of 3 feet: Sand Community San dy'Loam-❑ Clay Loam ❑ Clay ❑ Adobe❑ Hardpan ❑ Previous Application Made: If yes,date-----------------__) No ❑ New Construction.,Yes L] No E] FHA/VA: Yes El No E]PP [ TYPE OF INSTALLATION AND SPECIFICATIONS:, (No septic tank or cesspool permitted if public sew', is available within7200 feet.) nl, Septic Tank: Distance from nearest well_________________Distance from foundation_,_.___:___________'Material______________.______________________.____.____. •r' ❑ No. of compartments-------------------- -----Size-----------------------------_ _Li uid.'dg th___:---------------------_Capacity 1 OK Number from nearest well --------Distance from foundation___/Pl.._...____Distance to nearer Dispos field': Distance from lines_______.__f_ . � i L��n th of each line__- =_ _W dth of trench___________-------------- ------ Type Type of filter material_ _ _ Depth of filter material._-.L1��_.__.-. _..Total len th___ _f -- ------ Q .11: g l - Seepage Pit: Distance to nearest well----------------------Distance from foundation__________......__. Distance to nearest lot line________=_ ❑ Number of pits.`_----:----------- ---Lining ma�lterial--.--------------.----_Size: Diameter-----1- --'----f- '---Depth-----------------.-----`t------ Cess ool: Distance I� i p from nearest well_________________Distance from foundation___-______________.Ciningmaterial__________________._____-_______.___. G ❑ Size; Diameter--------------------- ---------------D!epth-------------- --------------Liquid.Capacity--------------------------:--gals. Privy: Distance from nearest well__.._____________-----------------------------Distance from nearest building-------------------------------__--------- ❑ Distance to nearest lot line--------------- Remodeling and/or '!(describe):------ --------------= t f l repairing -------� ----------------------------------------------------------- f -----------------•----------------------------------------------------------------- ------------ I ----------------------------------------------------------------------------------------------- ° . ------------------ --------------------------------------------------=--------------------•------------- -i--------------------------- ---------------------------------------------------- ----- 0 I hereby certify that I have prepared this applicationljand that the work will be done in accordance with San Joaquin County ordinances, State laws, and rules and regulations of the 56'n Joaquin Local Health District. (Signed) - ---------- -- - -- -d: ---------------------------------------------------`f' and/oar Contractor) By--------------- _"- -------- ---- aI ------------------------{Title) (Plot plan, showing size of lot, location of system in relati l to wells, buildings, etc., can be placed on reverse side). # FOR DEPARTMENT USE ONLY. APPLICATION ACCEPTED BY - ------------------------------------------------ DATE--- -(" ----------------------- REVIEWEDBY------------------------ ------------------- --------------------- --- 911---------------------------------------••------- DATE-------' A Alterations and ------------------ DATE.-------------------------- BUILDING PERMIT recommendations:SSUE ----------------------------------------------- - / ------------------------- --- ------II---------------------------------------•-•----------------------------------------------------- -------------------------------------------------------------------------------------- i --------------------------------------------- --------------------- ----------------------------- ------------------------�------------------•- -----'--=------------•------------------------- -------------------------- r-----------------------------------__----------------------------------------------------------------- -------- FINAL INSPECTION BY:---- ------------------------ - -------------- - - ------- -------- ;i SAN JOAQUIN LOCAL HEALTH DISTRICT "' - - i 1601 E.Hazelton Ave. 300 West Oak Street 124 Sycamore Street 205 West 9Th Street Stockfan,California •` Lodi,California Manteca,California Tracy,California + ES 9 REVISED 5-59 3M 3-'63 F.P.CD. 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