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FOR OFFICE USE: • ------------- --------------------------------- APPLICATION FOR SANITATION PERMIT Permit No. ------------------ ----- -- --------- ----- -- (Complete in Duplicate) This Permit'Expires^l Year Froin Date Issued Date Issued _��-�- I 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. JOB ADDRESS AND LOCATION .� .S2L� /1� - IRI>:,-----------------------------'Z04.LQ4._N---------------------- Owner's Name---_�n__��t1�=-�~�__.---------� ---- -------------------------------------------...- Phone-------------------------------- Addressp-r----...... ---------------------------:----------------------------------------------------- UGC; Contractor's Name---- x--R-�---j Vl-�•- --••---,-��------------------------ ------- ---------'---------------------------------- Phone--------•--•-------- Installation will serve: Residence [+ Apartmant House ❑ Commercial ❑ Trailer Court [] -Motel ❑ Other ❑ Number of living units: --.- Number of bedrooms `'Number of baths- ��___ Lot size _l�_o��.__�___- -'"�:____. ------ _ Water Supply: Public system [:] Community system El Private Depth to Wate i�.Table ft - Character of soil to a depth of 3 feet- Sand Er Gravel ❑; Sandy Loam ❑ Clay Loam ❑ Clay ❑ Adobe ❑ Hardpan ❑ Previous Application Made: (If yes,date_- ------ - ) NoA?—New Construction: Yes !a ❑ FHA/VA: Yesjffl--'No ❑ TYPE OF INSTALLATION AND SPECIFICATIONS: s>'t (No septic tank or cesspool-permitted if:public sewer-is available within 200"feet.) Septic >PklDistance from nearest well._., --Distance from foundation_A-)------------Materiji --__---. l! No-of compartments..---~,�._ --........--Size---�-----.��--.---Liquid depth_--DD- --- ------- Capacity.`�C�-_-_-- a � I}isposak Field: Nlumbere from of l neseares� well. _- Distance from foundation___D.._ _ fl3istance to nearest tat line___ ______ .._.-. +� __Length of each line....f---- _.-._.Width of trench-��............. Type of filter material_-RQ - Depth of filter material_--..6 K_ -_-.Total length_._.' �_� _ ------ � I Seepage Pit: Distance to nearest well-,--!-.-, Distance from foundation--------------------Distance to nearest lot line----- ---------- ❑ Number of pits--- ---------- 6Lining material---------------------- S'z:-Diaer------ A -- - Depth--------- --------- -------- -- Cesspool: Distance from nearest weal'`______________Distance from foundation----------------- - Lining materiaL.-----------------.---._...- Size: Diameter. -- ---------f '� -------------De Depth_ _..-- - -- '=`-,-------.........----------------Li uid Capacity ----- gals. �. ❑ s-_:. - p Distanc q p tY- - •---------------- Privy: Distance from nearest well---------------------------------- _... e from nearest building-----_---------------------------- ------ ❑ Distance to nearest lot 4ire- -------- ---------------------------------------------- ;----- --------------------------------------------------- Remodeling and/or repairing.(describe):-------- --------------------_.........- •-------------- •.° ==__ -- - ---------• -•-------------------------------------------------- -•------------------------------------------------------ s, ---------------------------------------------------------------------------- -----=----- .....=. - --- -------------- - ----- - -- - -- ---- I hereby certify that I'have prepared this application and that the work will be done in accordance with San Joaquin County , ordinances, State laws, and rules and re ulati ns of the San Joaquin Local Health District.,, (Signed)--.._-__ -- - - - - - - -- ------ � � - -- - - ------ ..- -- -.(Owner and/orContractor) (Plot plan, showing size of lot, location of system in relation % wells, buildings, etc., can be placed on reverse side). FOR DEPARTMENT USE ONLY i � , -.3/_"_ -- APPLICATION ACCEPTED BY------------ ---- ----��. _ -- ----1--------------------------- -------------- DATE...... --- --------------- REVIEWEDBY------------------------------------------- ------ ----------- - - ---- --- -------- -- ------------- DATE------___------------------------ ----- BUILDINGPERM I,T:.,ISSUED-------- -- ------------- --------------_-- -------------- ---------------------- '----------- DATE---------------------------- Alterationsand/ recommendations------------------ -------------------- ------ ----- -----•------ ------- ----------------------- -----•- ----------- --------------------------------------- ----- ----- ................... ------ ------------------- ---------------------- FINAL INSP - ION ------- Date----------- - 7731:7-.6,7.--------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 1601 E.Hasellon Ave. 300 West Oak Street 124 Sycamore Street 205 West 9th Street Stocktan,California Lodi. California Manteca,California Tracy,California E.H.9 2M 1-67 Vanguard press