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APPLICATION FOR SANITATION PERMIT Permit No. _j.-- --------- (Complete in Duplicate) Date Issued _ F cal Health District for a.permit to construct and install the work herein described. Application is hereby made to the San Joaquin Lo This application is made in compliance with County Ordinance No. 549. ov - -- JOB ADDRESS AND L&OAT ION_ ___r__--_____-- --- �--• --- •--•---•-----------•-� y -------------------------------------------------------- Owner'sPhone Name. •--- Address-------- ---------------- _ ___________ -- --------•--- Phone----------------------------------- t -------------------------- ----- Contractor's Name-------- ------- ------ -------- ------------------------------------------------------ -• Mote{ Other Installation will serve: Residence Apartment House ❑ Commercial ❑ Trailer Court ❑ ❑ ❑ Number of living units: __ Number of bedrooms __ Number of baths ___ __. Lot size "---- _ ___ Water Supply: Public system Ell Community system E] Private Depth to Water Table __1__--- , Character of soil to a depth of 3 feet: Sand E] Gravel [ISandy Loam ❑ Clay Loam [I Clay Adobe K Hardpan ❑ Previous Application Made: Yes ❑ No New Construction: Yes ElNo X FHA/VA: Yes ElNoX TYPE OF INSTALLATION AND SPECIE ICATIONS: (No septic tank or cesspool;permitted if public sewer is available within 200 feet.) Septic Tank: Distance from nearest welL__ __ ____.__-Distance from foundation__.-------- Material------------------------------ ------ compartments---- --------------------Size----------------------------=---Liquid depth-------------------------.Capacity--------- ----- Disl �os�alFieldt' Distance fromll No. o �_ d ___.Distance to nearest lot in ___-______ ineare t we!I_._�r�______.Distance from foundation____ �--- Number of lines______ Length of each line_____ __ Width of trench____ ----------------------- Number ----Total length -- a it Type of filter materia!_ -Depth of filter material-------- g Distance fro f u d tion______.,?_____-.Distance to nearest lot !irle_ - See age Pit: Distance to nearest well ,_- y ,, -` Depth__ Number of pits_____ __ _ ----------- rateriall - f D --------------- Cesspool: Distance fromiyynearest well-----------------Distance from foundation--------------------Lining material------------------------------- aIs. LiquidSapacify.. ------------------ _ #Siz_e: Diameter--------------------- --------- --;Depth-------------------------------------------------_- g _.❑ -------------------------------Distance from nearest building----------------------------------------- Distance Distance Pram nearest welL__________.____ Distance to nearest lot line------------------------------------------------------------------------- _ ---------------------- 1 Remodeling and/or repairing {describe_-----------------------_----------------------------------------------------------------------------------------------------------------=--------------- f ------•-----•------------------------- ----------------------------------------------------------------- -1------------------•-------------------------- ---------- ------ --------------------•--------------------•------------------ ---------------------------------------------------------------- --- - --------------- - 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 regulations of the San Joaquin Local Health District. dt --- (Owner and/or Contractor) Ow (Sign Title By----------------------------------------------------- - - - (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc., can be placed on reverse side). DEPARTMENT USE ONLY ;ZR DATE sAPPLICATION ACCEPTED BY--_:---•------------------- -- ----- -- REVIEWED BY------------------------------------- -------------------------- DATEDATE l' ------------------------------------------------------------- BUILDING PERMIT ISSUED------F------ ------------------------------------------------- ------------------------------ Alterations and/or recommendations------------------------------------------------------------- ------------------------------------ -- --- - ---- --- -- Date----------- J- � ------------------------------------ FINAL INSPECTION BY---------A.------ -------------------------------- SAN JOAQUIN LOCAL HEALTH DISTRICT 300 West Oak Street 132 Sycamore $frost 814 North "C" Street 13D South American Street 1 Tracy, California Stockton, California Lodi, California Manteca, California ftevisea 1-57 FY.CO.